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Good L,R,, Get Servim. <br />6014.11,100 ftreacm <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2203000093-9 Pages: 1 <br />Debtor Name: FOURTH STREET CAFE INC <br />Filing Date and Time: 03/01/2022 11:50 AM <br />Notice of State Tax Lien <br />202201539 <br />This Notioe 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 atter 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 1117N18 SPACE • <br />Nebraska ID Number <br />7251076 <br />Federal ID Number <br />470784697 <br />Lien Serial. Number <br />12267220 <br />L Ism reed llfim: <br />®Reglste of Deeds Q County Cleric <br />Social Seaally Number <br />Spouses Social Security Nungr <br />Dale of Lien <br />February 22, 2022 <br />Llan Type; <br />04/18/2020 <br />may' <br />HALL <br />1x1 Original ❑oonenuaron <br />=payer Name and Mailing Address <br />FOURTH STREET CAFE INC <br />D/B/A PAM'S PUD & GRUB <br />2848 S LOCUST <br />GRAND ISLAND NE 68801 <br />Tax Pea Tam <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />04/01/2019.12/3112019 <br />04/18/2020 <br />28,350.00 <br />5,670.00 <br />2,793.75 <br />.00 <br />36,813.75 <br />Sales <br />01/01/2020.01/31/2020 <br />11/02/2020 <br />1,440.39 <br />.00 <br />152.11 <br />.00 <br />1,592.50 <br />Sales <br />02/012020-12/312020 <br />02/01/2021 <br />5,838.51 <br />877.69 <br />360.08 <br />100.00 <br />7,176.28 <br />Sales <br />01/01/2021 -08/31!2021 <br />10/01/2021 <br />8,502.12 <br />735.80 <br />184.29 <br />.00 <br />9,421.21 <br />Saks <br />09/012021 -09/30/2021 <br />11/012021 <br />1,189.89 <br />118.99 <br />12.22 <br />.00 <br />1,321.10 <br />Sales <br />10/01/2021 - 10131/2021 <br />12/01/2021 <br />1,036.99 <br />103.70 <br />8.01 <br />.00 <br />1,148.70 <br />Sales <br />11/0/2021 - 11/30/2021 <br />01/03/2022 <br />1,232.30 <br />123.23 <br />6.48 <br />.00 <br />1,362.01 <br />Total <br />58,836.55 <br />sig <br />here <br />n <br />I matey mel the Nebraska Department of Revenue has congaad waft the laws of the Slap of Nebraska in deweinht9 the amount shown to be due. <br />and that tel taxpayer hes hied Io pay the amount due OK damsel. This Nonce of Slate Tax Lien is an dYct ere lien and agrees to cornua the prarlty et <br />the State Interest In the aeected property of dna taxpayer. <br />teak .0R. w i2tOt- Revenue Ascent <br />Signa' <br />Tile <br />Revenue Supervisor <br />02125/2022 402.4714717 <br />Dabs <br />Tale <br />Phan* Number <br />022 <br />Date <br />4.494 -tale Rem 840114 Supersedes 4440.1074 Ree 11-S010 <br />