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N_FBIZA &K A <br />Uoccl Lie Great Serv,ce <br />014•11. or, 00 111.11.04 <br />20210319,4 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2104001138-8 Pages: 1 <br />Debtor Name: FAMOS CONSTRUCTION INC <br />Filing Date and Time: 04/20/2021 10:03 AM <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 />9046003 <br />Federal 0 Number <br />200934097 <br />Lien Serial Number <br />12171580 <br />Lien Filed With: <br />Social Security Number <br />Spouse's Social Security Number <br />ci Register of Deeds fi♦ County Clerk <br />Date d Lien <br />April 8, 2021 <br />Liao Type: <br />Dcorrecied <br />County <br />NALL <br />Q original ■ Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />FAMOS CONSTRUCTION INC <br />PO BOX 1665 <br />GRAND ISLAND NE 68802 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Withholding <br />01!01/2019-03/31/2019 <br />05/10`2019 <br />.00 <br />17.80 <br />23.37 <br />.00 <br />41.17 <br />Withholding <br />04/01/2019-06;30/2019 <br />08/12/2019 <br />.00 <br />21.64 <br />22.98 <br />.00 <br />44.62 <br />Withholding <br />07./01/2019-09/30`2019 <br />11/12/2019 <br />314.45 <br />18.14 <br />22.811 <br />.00 <br />355.47 <br />Withholding <br />10/01/2019- 12/31/2019 <br />02/10/2020 <br />.00 <br />21.64 <br />6.78 <br />.00 <br />28.42 <br />Withholding <br />07/01/2020-09/30%2020 <br />11%10/2020 <br />408.60 <br />20.43 <br />6.70 <br />.00 <br />435.73 <br />Withholding <br />10/01/2020- 12/31%2020 <br />02'10%2021 <br />469.62 <br />23.48 <br />2.59 <br />.00 <br />495.69 <br />Total <br />1,401.10 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has compiled with the laws o1 the Stale of Nebraska in determining the amount shown lobe due, <br />and that the taxpayer has Lied to pay the amount due aper demand. This Notice of State Tax Lien is an effective Ken and serves to cootnue the priority of <br />the/Slates interest +) the affected_ property at the taxpayer. <br />.1 Revenue Agent <br />Mature <br />Authorized Si <br />Title <br />Revenue Senior Agent <br />03/31/2021 402-471-5956 <br />Date 'hone Number <br />Tinto <br />Date <br />.494-1974 Rev. 8.1018 Supersedes 44.9-1974 R. a-2013 <br />