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202106350
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7/26/2021 4:00:27 PM
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7/26/2021 4:00:27 PM
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202106350
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n cao <br />�,,46'.. <br />Gxd Life. Great Sex vice. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2107001562-8 <br />Debtor Name: S -FIVE PROMOTIONS INC <br />Filing Date and Time: 07/26/2021 11:22 AM <br />Pages: 1 <br />Notice of State Tax Lien <br />202106350 <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 tights 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 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />/3549480 <br />Federal D Number <br />204787022 <br />Lien Serial Number <br />12103184 <br />Lien Red With: <br />® Register of Deeds ❑ County clerk <br />Social Security Number <br />No SS# <br />Spouse's Social Security Number <br />Date of Lien <br />July 19, 2021 <br />Lien Type: <br />❑Corrected <br />County <br />HALL <br />G7.1 Orginel 0Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />S -FIVE PROMOTIONS INC <br />CSD AMERICAN SHAMAN <br />2834 OLD FAIR RD <br />GRAND ISLAND NE 68803 <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 />06'01/2020-06/30/2020 <br />01/11/2021 <br />1,615.00 <br />323.00 <br />62.82 <br />.00 <br />2,000.82 <br />Sales <br />07/01/2020 - 07/31/2020 <br />01/11/2021 <br />1,615.00 <br />323.00 <br />55.96 <br />.00 <br />1,993.96 <br />Sales <br />08/01/2020 - 08/31/2020 <br />11/02/2020 <br />1,615.00 <br />323.00 <br />49.11 <br />.00 <br />1,987.11 <br />Sales <br />09/01/2020 - 09/30/2020 <br />01/11;2021 <br />1,615.00 <br />323.00 <br />42.47 <br />.00 <br />1,980.47 <br />Sales <br />10/01/2020 -10/31/2020 <br />05/21/2021 <br />2,000.00 <br />400.00 <br />44.11 <br />.00 <br />2,444.11 <br />Sales <br />11/01/2020-11/30/2020 <br />02/01/2021 <br />2,000.00 <br />400.00 <br />35.89 <br />.00 <br />2,435.89 <br />Sales <br />12/01/2020 - 12/31/2020 <br />05/21/2021 <br />2,000.00 <br />400.00 <br />29.59 <br />.00 <br />2,429.59 <br />Sales <br />01/01/2021 - 01/31/2021 <br />05/21/2021 <br />2,000.00 <br />400.00 <br />24.50 <br />.00 <br />2,424.50 <br />Sales <br />02/01/2021 -02/28/2021 <br />05/21/2021 <br />1.000.00 <br />200.00 <br />9.94 <br />.00 <br />1,209.94 <br />Withholding <br />0410112020-06/30/2020 <br />01/11/2021 <br />275.00 <br />82.50 <br />10.28 <br />.00 <br />367.78 <br />Withholding <br />07/01/2020 - 09130/2020 <br />01/11/2021 <br />275.00 <br />41.25 <br />6.82 <br />.00 <br />323.07 <br />Total <br />19,597.24 <br />i Certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in delermirrng the amount shown Is be due, <br />and that the taxpayer has felled to pay the amount due after demand. This Notice of State Tax Lien is en effective lien and serves to continue the priority of <br />the Slate's interest In the affected properly of the taxpayer. <br />sign,,. .jf,..YYl& <br />here r Preparers Saqre <br />St rel L <br />Authori q <br />Revenue Agent <br />Title <br />Revenue Senior Agent <br />07/12/2021 402-471-6067 <br />Date <br />Title <br />Phone Number <br />07/19/2021 <br />Date <br />4.494-1974 Pee 8.2818 Supertad.s 4.949.1574 pen, 84513 <br />
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