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NEBRASKA - <br />Goad Life. Great. Serv,ce. <br />202205487 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2207001481-3 Pages: 1 <br />Debtor Name: GILL DIESEL <br />Filing Date and Time: 07/26/2022 10:54 AM <br />Notice of State Tax Lien <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 10 Number <br />12892408 <br />Federal ID Number <br />474144311 <br />Lien Serial Number <br />12210513 <br />Lien Flied With: <br />ix Register of Deeds ❑ County Clerk <br />Social Security Number <br />NO SSN <br />Spouses Social Security Number <br />NO SPOUSE SSN <br />Date of Lien <br />July 20, 2022 <br />Lien Type: <br />(j Original ElContinuation 0Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />GILL DIESEL <br />5076 W ABBOTT ROAD <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 />12/01/2019 - 12/31/2019 <br />01/20/2020 <br />.00 <br />.00 <br />6.65 <br />20.00 <br />26.65 <br />Sales <br />02/01/2020 - 02/29/2020 <br />03/26/2020 <br />.00 <br />108.70 <br />57.20 <br />20.00 <br />185.90 <br />Sales <br />07/01/2020 - 07/31/2020 <br />08,!25/2020 <br />574.31 <br />156.03 <br />146.21 <br />20.00 <br />896.55 <br />Sales <br />11/01/2020- 11/30/2020 <br />02/01/2021 <br />2,447.29 <br />.00 <br />128.91 <br />20.00 <br />2,596.20 <br />Sales <br />12/01/2020 - 12/31/2020 <br />01/28/2021 <br />475.03 <br />67.50 <br />28.90 <br />20.00 <br />591.43 <br />Sales <br />08./01/2021 -08/31/2021 <br />10/01/2021 <br />.00 <br />178.46 <br />.00 <br />.00 <br />178.46 <br />Sales <br />01/01/2022-01/31/2022 <br />02/28/2022 <br />514.75 <br />50.19 <br />6.34 <br />20.00 <br />591.28 <br />Sales <br />02/01/2022 - 02/28/2022 <br />03/20/2022 <br />719.97 <br />.00 <br />7.22 <br />20.00 <br />747.19 <br />Withholding <br />10/01/2021 -12/31/2021 <br />02/10/2022 <br />3,186.24 <br />15931 <br />44.51 <br />20.00 <br />3,410.06 <br />Total <br />9,223.72 <br />I certify Mal 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 atter demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />the Stales interest in the affected property of the taxpayer. <br />sign ere , <br />here Prepaignal <br />Authorized Signature <br />Revenue Agent <br />Tale <br />Revenue Supervisor <br />07/20/2022 402-471-5870 <br />Date <br />Trite <br />Phone Number <br />Date <br />x.494-197. flea. 5.2Lte summed... -Ems -19A tree e.zma <br />