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REERASKA- <br />Good Life. c;•eut Se•v,ce <br />0806e7a1,11. o. savaxr., <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2303000277-8 Pages: 1 <br />Debtor Name: HAVANA NIGHT LLC <br />Filing Date and Time: 03/07/2023 09:24 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 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />13683861 <br />Federal ID Number <br />843050962 <br />Lien Serial Number <br />12315075 <br />Lien Fled With: <br />55 Register of Deeds ❑ County Clerk <br />Serial Security Number <br />Spouse's Social Security Number <br />Date of lien <br />February 23, 2023 <br />Lien Type: <br />jOriginal El Continuation El Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing 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 />03/01/2022 - 07/31/2022 <br />12/03/2022 <br />1,975.00 <br />395.00 <br />46.14 <br />.00 <br />2,416.14 <br />Withholding <br />01/01/2022 -06/30/2022 <br />12/03/2022 <br />790.00 <br />237.00 <br />18.76 <br />.00 <br />1,045.76 <br />Total <br />3,461.90 <br />sign <br />here <br />I 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 tailed to pay the amount due after demand. This Notice of State Tax Lien is en effective lion and serves to continue the priority of <br />the States interest in the affected property of the taxpayer. <br />4444, LazA -P Revenue Agent <br />03/02/2023 402-471-5717 <br />Preparer's Signarere Title Date Phone Number <br />Revenue Supervisor <br />Authorized Signature <br />Title DOS <br />4-494.1874 Rev. 9.2018 Supersedes 4.049.1974 Rev. 8.2013 <br />