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202106887
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8/11/2021 3:50:54 PM
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8/11/2021 3:50:54 PM
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DEEDS
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202106887
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Good Life, Great- 5e o, o. <br />xw,.s., ar.wnaw <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2108000610-6 Pages: 1 <br />Debtor Name: MENDEZ ENTERPRISES LLC <br />Filing Date and Time: 08/11/2021 10:35 AM <br />Notice of State Tax Lien <br />202106887 <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 iien.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 INTHIS SPACE <br />Nebraska ID Number <br />13408496 <br />Federal ID Number <br />821268132 <br />Lien Serial Number <br />12103479 <br />Lien Filed With: <br />ly1 Register or Deeds D County Clerk <br />Social Security Number <br />Spouse's Social Security Number <br />Date of Lien <br />August 5, 2021 <br />Lien Type: <br />DCorrected <br />County <br />HALL <br />® Original • Continuation <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />MENDEZ ENTERPRISES LLC <br />D.B!A MENDEZ ENTERPRISES <br />2404 WEST LINCOLN HWY <br />GRAND ISLAND NE 68801 <br />Tux Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />01/01/2020-09/30'2020 <br />12/01/2020 <br />16,648.68 <br />900.57 <br />710.50 <br />.00 <br />18,259.75 <br />Withholding <br />01101/2020-0913012020 <br />11/10/2020 <br />5,935.55 <br />1,017.10 <br />246.89 <br />.00 <br />7,199.54 <br />Withholding <br />10/01/2020- 12/31/2020 <br />03/25/2021 <br />2,119.90 <br />106.00_ <br />31.88 <br />.00 <br />2,257.78 <br />Total <br />27,717,07 <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the State's interest In the affected property of the taxpayer. <br />sign ,paec Revenue Agent 08/05/2021 402-471-5717 <br />here PrsfrSig'p <br />Title Data Phone Number <br />%'t /`y `" '" Revenue Senior Agent <br />8-5-21 <br />ANhodzed Signature Title Date <br />494-1574 Rev. 82015 Supesedes 4440.1574 Ra,.82013 <br />
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