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** PLEASE RETURN ORIGINAL TO ** <br />COMPLIANCE DIVISION <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN, NE 68509-4609 <br />NEB AS -14A <br />Good Life. Creat 9erv=co. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2110001026-5 Pages: 1 <br />Debtor Name. PRIMOS TOWING AND RECOVERY <br />Filing Date and Time: 10/26/2021 1138 AM <br />Notice of State Tax Lien <br />202109070 <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 />13341340 <br />Federal ID Number <br />833165559 <br />Lien Serial Number j Lion Filed With: <br />12105008 Q Register or Deeds 0 County Clerk <br />Social Security Number <br />XXX -XX -8824 <br />Spouses Sodal Security Nunioer <br />Data o1 Lien Lien Type: <br />October 19, 2021 i ® Original f Continuation ā¯‘corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />CIPRI.ANO GONZALEZ LUITA <br />213 N GARFIELD AVE <br />GRAND ISLAND NE 68801 <br />PRIMOS TOWING AND RECOVERY <br />213 N GARFIELD AVE <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 />03/01/2021 - 03/31/2021 <br />05/27/2021 <br />7,562.48 <br />868.75 <br />471.09 <br />,00 <br />8,902 32 <br />Sales <br />04/01/2021 -04/30/2021 <br />06/01/2021 <br />.00 <br />25.00 <br />.01 <br />.00 <br />25.01 <br />Total <br />8,927.33 <br />sign <br />here <br />I codify that the Nebraska Deparunent of Revenue has complied with the taws of the State of Nebraska in determining Ine amount shown to be due, <br />and that the taxpayer has tailed 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 StaIBs interest in Rxaaffected property of the taxpayer. <br />tgnature <br />-Z-10-21 Revenue Agent 10/19/2021 308-535-8293 <br />Tete tato Phone Number <br />Revenue Supervisor /0 - f f -P4 a <br />Au or <br />Title Date <br />4..:94-1074 Rev. 8-2018 Supmcoaes 4-849-1974 9ev. (1.2013 <br />