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1 C2C2 D�...< Arr&KA— <br />Good '_de. treat Servo .*. <br />20210185 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2103000325-6 <br />Debtor Name: WILLIS WORKWEAR LLC <br />Filing Date and Time: 03/05/2021 09:26 AM <br />Pages: 1 <br />Notice of State Tax Lien <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including penalties, interest, and costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand.These taxes are a lien for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this lien. This lien will expire and <br />become unenforceable 10 years after the date of recording if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />12683167 <br />Federal ID Number <br />814289230 <br />Lien Serial Number <br />12167536 <br />Len Filed Wan: <br />[] Register of Deeds 0 County Clerk <br />Social Security Number <br />Spouses Swot Security Number <br />Dale of Len <br />January 20, 2021 <br />Len Type: <br />® Original 0Continuation <br />02/03/2020 <br />County <br />IIALL <br />II Corrected <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />WILLIS WORK WEAR LLC <br />2621 BRAHMA ST <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />09/01/2019 - 09/30/2019 <br />02/03/2020 <br />.00 <br />10.38 <br />3.11 <br />.00 <br />13.49 <br />Sales <br />10/01/2019-10/31/2019 <br />04/10/2020 <br />360.00 <br />72.00 <br />20.67 <br />.00 <br />452.67 <br />Sales <br />11/01/2019- 11/30/2019 <br />04/10/2020 <br />360.00 <br />72.00 <br />19.19 <br />.00 <br />451.19 <br />Sales <br />12/01/2019 - 12131/2019 <br />04/10/2020 <br />360.00 <br />72.00 <br />17.66 <br />.00 <br />449.66 <br />Sales <br />02/01/2020 - 02/29/2020 <br />11/02/2020 <br />.00 <br />25.00 <br />2.67 <br />.00 <br />27.67 <br />Total <br />1,394.68 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue ties complied with the laws of the State of Nebraska In determining the amount shown a be due. <br />end that the taxpayer has failed to pay the amount due alter demand. This Notice of State Tax Lien Is art elbebve sten and serves to continue the priority of <br />the j3Dte s interest" the aaected.praperty of the taxpeym. <br />6111si�y!� Revenue Agent 01/13/2021 402-471-5956 <br />Title Date Phone N` er <br />Revenue Senior Agent 3/x%2.02,' <br />ignature <br />3Zd <br />Aufrorized <br />'Qoseato 7f <br />Tllle <br />Date <br />u4e4.l514 Rev. 6-2018 Snoe e.Sea 4-948.1974 Rue. 842013 <br />