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NEBRASKA - <br />coed Lite. ;sear. Senece. <br />ew.a*«w, or ae s.wx <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2211000142-3 Pages: 1 <br />Debtor Name: SPORTSMANS BAR <br />Filing Date and Time: 11/07/2022 08:33 AM <br />Notice of State Tax Lien <br />202207870 <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 Iien.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 INTHIS SPACE <br />Nebrases ID Number <br />13292005 <br />Federal I0 Number <br />830957857 <br />Len Serial Number <br />12212950 <br />Lien Fted Witte. <br />® Register of °Gees 0Coumy Clerk <br />Social Security Number <br />NO SSN <br />Spouse s BOCIa1 Secwrty Number <br />NO SPOUSESSN <br />Date ol Lien <br />October 31, 2022 <br />Lien Type: <br />J Original CaContinuation ElCorrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />SPORTSMANS BAR <br />501 N PINE STREET <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period Date of <br />Assessment <br />Tar <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />01101/2021 -04.'30/2022 108/01/2022 <br />12.019.00 <br />974A1 <br />605.58 <br />.00 <br />13,598.99 <br />Total <br />13,598.99 <br />I certify Met 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 1ie0 is an effective lien and serves to continue the priority of <br />the State's interest irk the affected property of the taxpayer. <br />sign ` <br />ti � ��"l i E:�':���'� Revenue Agent 10/31/2022 402-370-3345 <br />here • Praparer'sSranee <br />C <br />Authorised Serrature <br />Tide Date Phone Number <br />Revenue Supervisor <br />/(9 40 '`'-2-- <br />Title Date <br />4.494.2974 Pest 04018 Sue les 4.949-1974 Acv. 0-2013 <br />