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d-6 <br />w>cd Life. Croat Service. <br />PWMINWroI44vmp'e <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2302000305-1 Pages: 1 <br />Debtor Name: BRAD SCELLIN <br />Filing Date and Time: 02/08/2023 10:08 AM <br />Notice of State Tax Lien <br />202300630 <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 am 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 IN THIS SPACE <br />Nebraska ID Number <br />13549480 <br />Federal ID <br />204787022 <br />Number <br />Lien Serial Number <br />12314660 <br />Lien Filed With: <br />Social Security Number <br />NO SSN <br />Spouse's Seciel Security Number <br />NO SPOUSE SSN <br />Register of Deeds ❑County Clark <br />Date of Lien <br />February 2, 2023/,'4 <br />Lien Type: <br />❑Corrected <br />County <br />HALL <br />Original ❑Continuation <br />u Name and Location Address <br />Taxpayer Name and Mailing Address <br />BRAD SCELLIN <br />S -FIVE PROMOTIONS INC <br />131 EMAIN STAPT 41 <br />SEWARD NE 68434 <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 />08/01/2019 -08/312019 <br />10/01/2019 <br />.00 <br />.00 <br />1.04 <br />.00 <br />1.04 <br />Sales <br />09/01/2019 - 09/302019 <br />12/02/2019 <br />.00 <br />.00 <br />2.10 <br />.00 <br />2.10 <br />Sales <br />11/01/2019 - 11130/2019 <br />03/02/2020 <br />.00 <br />.00 <br />10.18 <br />.00 <br />10.18 <br />Sales <br />12/012019 - 03/31/2020 <br />07/05/2020 <br />.00 <br />1,124.00 <br />445.64 <br />.00 <br />1,569.64 <br />Sales <br />04/01/2020 - 04/30/2020 <br />06/01/2020 <br />.00 <br />.00 <br />.85 <br />.00 <br />.85. <br />Sates <br />05/01/2020 - 05/312020 <br />07/01/2020 <br />.00 <br />83.44 <br />.53 <br />.00 <br />83.97 <br />Sates <br />06/01/2020 - 09/30/2020 <br />01/11/2021 <br />3,720.84 <br />969.00 <br />385.93 <br />.00 <br />5,075.77 <br />Sales <br />08/01/2020-08/31/2020 <br />11/02/2020 <br />1,615.00 <br />323.00 <br />126.70 <br />100.00 <br />2,164.70 <br />Sales <br />10/01/2020 - 1.0/312020 <br />05/21/2021 <br />2,000.00 <br />400.00 <br />140.30 <br />.00 <br />2,540.30 <br />Sales <br />11/01/2020- 11/30/2020 <br />02/01/2021 <br />2,000,00 <br />400.00 <br />132.08 <br />100.00 <br />2,632.08 <br />Sales <br />12/01/2020 - 02/28/2021 <br />05/21/2021 <br />7,500.00 <br />1,000.00 <br />339.42 <br />.00 <br />8,839.42 <br />Total <br />22,920,05 <br />sign <br />here <br />I candy 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 />aro that the taxpayer has tailed le pay the amount due alter demand. This Notice of State Tan Lien is en ertaokve lien and serves le oonenue the petorhy of <br />the State's interest in the apected property of the taxpayer. <br />/�l4lLt'Y <br />Preparers Sign <br />w. - <br />Au sized Signature <br />Revenue Tax Specialist Senior 01(2612023 402-471-6067 <br />Title <br />Revenue Supervisor <br />Date <br />Title <br />Phone Number <br />2/3/2023 <br />Date <br />4.494.1974 REN .14018 Suparsedes 4449,1974 Ren. 8-2013 <br />