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Good Lire, Greet Serv,`E,. <br />0[0.101.111 M 10[Y[WY <br />202206805 <br />NE Sec of State - Robert B. Ewen <br />Filing Document #: 2209000728-2 Pages: 1 <br />Debtor Name: HAVANA NIGHT LLC <br />Filing Date and Time: 09/20/2022 09:28 AM <br />Notice of State Tax Lien <br />This Notice of State Tax Uen 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 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />13683861 <br />Federal ID Number <br />843050962 <br />Lien Serial Number <br />12211618 <br />Lien Filed With: <br />Social Security Number <br />NO SSN <br />Spouses Social Security Number <br />NO SPOUSE SSN <br />tti9 Register of Deeds ■ County Cleric <br />Date of Lien <br />September 8, 2022 <br />Lien Type: <br />© Original ❑Continuation ❑Corrected <br />County <br />HALL <br />Business Name and Location Address <br />axpeyer Name and anauing Address <br />HAVANA NIGHT LLC <br />HAVANA NIGHT <br />108 W 14TH ST <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 />02/01/2020 - 02/29/2020 <br />09/18/2021 <br />249.82 <br />50.00 <br />22.48 <br />.00 <br />322.30 <br />Sales <br />09/01/2020 - 05/312021 <br />09/18/2021 <br />2,250.00 <br />450.00 <br />106.73 <br />.00 <br />2,806.73 <br />Sales <br />06/01/2021 - 08/31/2021 <br />11/01/2021 <br />.00 <br />50.00 <br />.39 <br />.00 <br />50.39 <br />Sales <br />09/01/2021-02282022 <br />07/01/2022 <br />1,890.00 <br />378.00 <br />38.30 <br />.00 <br />2,306.30 <br />Withholding <br />01/01/2020 - 03/31/2020 <br />09/18/2021 <br />250.00 <br />87.50 <br />21.05 <br />.00 <br />358.55 <br />Withholding <br />07/01/2020-03/31/2021 <br />09/I8/2021 <br />750.00 <br />237.50 <br />36.96 <br />.00 <br />1,024.46 <br />Withholding <br />04/01/2021 - 12/31/2021 <br />07/01/2022 <br />945.00 <br />315.00 <br />24.24 <br />.00 <br />1,284.24 <br />Total <br />8,152.97 <br />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 en effective lien and serves to continue the priority of <br />the Slate's interest in the elected properly of the taxpayer. <br />sign L ac... Ltia4P - <br />here P'eParer's Signature —, <br />Authorized Signature <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />09/13/2022 402-471-5717 <br />Date Phone Number <br />Title <br />1-71,7.. <br />Date <br />4.494.1 074 Pew e-2018 Sepersedes 4.949.1974 Rev. 04013 <br />