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Good Life. Great Sery cn. <br />b6l14MMINV W ,tVCNVC <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2204000794-0 Pages: 1 <br />Debtor Name: G I ENTERPRISES LLC <br />Filing Date and Time: 04/15/2022 09:21 AM <br />Notice of State Tax Lien <br />2022027'99 <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 ail 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 />7484410 <br />Federal ID Number <br />470794170 <br />Lien Serial Number <br />12208116 <br />Lien Hied Wirth: <br />NI Register 01 Deeds 0 County Clark <br />Social Security Number <br />NO SSN <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Dale of Lien <br />March 30, 2022 <br />Lien Type: <br />® D:iginal ❑com.uation ❑cofracied <br />Camty <br />}FALL <br />useless Name and Location Address <br />Taxpayer Name and Mailing Address <br />G I ENTERPRISES LLC <br />10102 S 173RD CIRCLE <br />OMAHA NE 68136 <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 />04/01/2019-06/3012019 <br />08/12/2019 <br />1.479.73 <br />298.39 <br />225.96 <br />60.00 <br />2,064.08 <br />Withholding <br />10.0112019- 12/31/2019 <br />12/26/2019 <br />.00 <br />.00 <br />.00 <br />20.00 <br />20.00 <br />Total <br />2,084.08 <br />I certify that the Nebraska Department of Revenue has complied with the taws of the Stale of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has tailed to pay the amount due after demand. This Notice of State Tar Lien is an ellective lien and serves to continue the priority of <br />the State's interest in the affected property of the taxpayer. <br />sign /P-44 Ite.C.4, Revenue Agent 04/06/2022 402-471-5717 <br />here <br />grmture Tete Date Phone Number <br />Revenue Supervisor 14/116/21122_ <br />Authorized Signature Title Date <br />4.494.1974 Rev. a -cots SUaereedes 4.949-19M Rey 8-2019 <br />