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011M111171R47 Of MVO.. <br />202207736 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2210001022-8 Pages: 1 <br />Debtor Name: NEW YORK PIZZA AND ITALIAN RESTAURA <br />Filing Date and Time: 10/31/2022 10:16 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 />14835444 <br />Federal ID Number <br />870921203 <br />Lien Serial Number <br />12212765 <br />Lwn Filed With: <br />® Register of Deeds O County Cie <br />Social Security Number <br />NOS,9N <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Date of Lien Lien Type: <br />October 28, 2022 ® Original ®Continuation <br />Business Name and Location Address <br />County <br />❑Corrected I HALL <br />Taxpayer Name and Mailing Address <br />NEW YORK PIZZA AND ITALIAN RESTAURANT <br />3404 W 13T11 ST SUITE 162 <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 />09/01/2021 -09%30,2021 <br />11/01/2021 <br />1,632.98 <br />551.63 <br />91.27 <br />.00 <br />2,275.88 <br />Sales <br />12/01/2021 - 12/31/2021 <br />07101/2022 <br />1,18123 <br />.00 <br />35.54 <br />.00 <br />1,218.77 <br />Sales <br />03/01/2022-03131;2022 <br />07/01.2022 <br />1.611.02 <br />161.10 <br />25.28 <br />.00 <br />1,797.40 <br />Sales <br />06/01/2022 - 06/302022 <br />09101/2022 <br />4,602.78 <br />535.93 <br />38.59 <br />.00 <br />5,177.30 <br />Sales <br />07101/2022 - 07,31/2022 <br />09/0112022 <br />• 1,365.88 <br />136.59 <br />7.75 <br />.00 <br />1,510.22 <br />Withholding <br />07/01/2021 - 09/30/2021 <br />05/ 10/2022 <br />100.56 <br />15.08 <br />3.00 <br />.00 <br />118.64 <br />Total <br />12,098.21 <br />sign <br />here <br />I certify that Inc Nebraska Depaetment of Revenue has complied with the laws of the State of Nebraska m determining the amount shown to be due. <br />and that the taxpayer has faked to pay the amount due atter demand. This Notice of State Tax Lien is an effective lien and serves to continue the priorly of <br />Me State's inter ggL.i9 the ateg d property 01 the taxpayer. <br />era Signature <br />Authorized Sign <br />Revenue Supervisor 10/21/2022 402-471-5704 <br />title Dale Phone� N <br />enCer — <br />Revenue Manager 2 Ze22„ <br />Title Dale <br />4.4941974 Rev. 8.2018 Supersedes 4.949.1974 Rev. 8.2013 <br />