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N1 -B AGKA• <br />Or..at @e'v-csr_ <br />ef..e.e., er.awerwc <br />202603925 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2308000040-1 Pages: 1 <br />Debtor Name: LANDELL HEALTH &amp; WELLNESS LLC <br />Filing Date and Time: 08/02/2023 10:58 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 Thi1S SP <br />Nebraska ID Number <br />13366289 <br />Lien Sartre Number <br />12318040 <br />Date of Lien <br />July 26, 2023 <br />Federal ID Number <br />833982181 <br />lien Filed With: <br />Ni Register of Deeds County Clerk <br />Social Security Number <br />NO SSN <br />sness Na <br />Lien Type: <br />OriOnal <br />e and Location Address <br />Continuation <br />Corrected <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />County <br />Taxpayer Name and Mailing Address <br />LANDELL HEALTH & WELLNESS LLC <br />D/B/A COMPLETE NUTRITION <br />1115 ALLEN DRIVE SUITE C <br />GRAND ISLAND NE 68803 <br />Tax Pro <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />interest <br />Costs <br />Total Due <br />Withholding <br />04101/2020-0331/2021 <br />08/10/2021 <br />.00 <br />55.33 <br />3.71 <br />.00 <br />59,04 <br />Withholding <br />04/01/2021 - 12/31%2021 <br />03/25/2022 <br />.00 <br />76,36 <br />4.44 <br />.00 <br />80,80 <br />Withholding <br />01;01/202"-09/3012022 <br />02/10;2023 <br />.00 <br />54,53 <br />3.50 <br />.00 <br />58.03 <br />Withholding <br />10/01/2022 - 12/31/2022 <br />03/27/2023 <br />39.21 <br />1.96 <br />.69 <br />.00 <br />41.86 <br />Total <br />239.73 <br />I certify that the Nebraska Department of Revenue has complied with the taws of the Slate of Nebraska in determining the amount shown to be due, <br />and that the taxpayer tuts failed to pay the amount due after demand. This Notice of State Tax Lien Is an effective lien and serves to comtnue the priority of <br />the States interest In the 98ected property of the taxpayer. <br />sign <br />here ' P'epa <br />QCC:Ii LffCliltZT/©Q Revenue Agent 07/26/2023 402-471-5717 <br />Authorized Signature <br />Title Date Phone Number <br />Revenue Supervisor <br />Title <br />Dale <br />4-sa0•1ab Rev.84YAra Steersedua s.949-104 aev.8.20!a <br />