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Gaud Lee. Great Serw:e_ <br />202207000 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2209001027-7 Pages: 1 <br />Debtor Name: 4M CLEANING LLC <br />Filing Date and Time: 09/28/2022 11:12 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 Nen. 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 />12904252 <br />Federal ID Number <br />820983943 <br />Lien Serial Number <br />12211659 <br />Lien Filed With: <br />® Register of Deeds El County Clerk <br />Social Security Number <br />NO SSN <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Dare of Lien <br />September 20, 2022 <br />Lien Type: <br />® Original 0CoMinuation El Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />4M CLEANING LLC <br />Dli3/A 4M CLEANING <br />1014 SOUTH PLUM <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 />02101/2019 - 09/30/2019 <br />01/24/2020 <br />3,084.33 <br />1,192.00 <br />479.96 <br />.00 <br />4,756.29 <br />Sales <br />02%01'2019-09/3012019 <br />01/24/2020 <br />8,276.09 <br />827.61 <br />1,051.30 <br />.00 <br />10,155.00 <br />Sales <br />10101/2019- 12/31/2020 <br />09/04/2021 <br />13,970.00 <br />2,794.00 <br />1,048.44 <br />.00 <br />17.812.44 <br />Sales <br />10.01/2019- 12/31/2020 <br />09/04/2021 <br />17,682.51 <br />1,768.26 <br />1,197.35 <br />.00 <br />20,648.12 <br />Sales <br />01/01/2021 - 09/30/2021 <br />11/01/202I <br />10,361.03 <br />723.69 <br />402.69 <br />.00 <br />11,487.41 <br />Withholding <br />07/01.12019 - 06/30/2020 <br />081l0/2020 <br />1,539.93 <br />243.25 <br />138.25 <br />.00 <br />1.921.43 <br />Withholdine <br />07%0112020- 12/31:2020 <br />09/1412021 <br />830.00 <br />290.50 <br />45.25 <br />.00 <br />1,165.75 <br />Withholding <br />07/01/2020 - 12/31/2020 <br />09/04/2021 <br />713.66 <br />178.41 <br />32.55 <br />.00 <br />924.62 <br />Withholding <br />0101/2021 -09/3012021 <br />I1/I0/2021 <br />2,925.43 <br />433.78 <br />99.64 <br />.00 <br />3,458.85 <br />Total <br />72,329.91 <br />I certify that the Nebraska Department of Revenue has complied with the taws of the State of Nebraska in determining the amount shown to be due. <br />and that the taxpayer has faded to pay the amount due after demand. This Notice of State Tax Lien is an effective Ben end serves to continue the priority of <br />the Slate's Interest In thee affected property of the taxpayer. <br />Sign' /he404.GCL (.(/ � !-L Revenue Agent 09/20/2022 402-471-5717 <br />here Preporer's Signature Title late <br />Revenue Senior Agent <br />Authorized Signature <br />Title <br />Phone Number <br />9-21-2022 <br />Date <br />4.464.1974 ftev.S-2e19 Senersedes 4.949.15374 Rev. 64(113 <br />