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N C I/ A <br />t 'ea-: Se/':;;:P:. <br />INIA.n Nt os arramo <br />202303926 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2308000039-5 Pages: 1 <br />Debtor Name: DAWN SICH <br />Filing Date and Time: 08/02/2023 10:57 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 tien.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 />14914395 <br />Federal ID Number <br />NO FEIN <br />uen Serial Number <br />12318398 <br />i Lien Pied With. <br />i tdegiaterof Deeds DCountyclera <br />Social Security Number <br />XXX -XX -1766 <br />Spouse's Socia, Socurity Number <br />NO SPOUSE SSN <br />Date el Len <br />July 26, 2023 <br />Uer Type: <br />© Original 0Continuation 7Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />DAWN S1CH <br />3304 W CAPITAL. AVE <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 />06/01/2022 - 06/30/2022 <br />06/01/2023 <br />1,699.65 <br />.00 <br />71.11 <br />.00 <br />1,770.76 <br />Sales <br />09/01/2.022 - 09/30/2022 <br />06/01/2023 <br />1,692.19 <br />169.22 <br />58.01 <br />.00 <br />1,919.42 <br />Sales <br />12;01.2022 - 12131/2022 <br />06/01/2023 <br />2,030.37 <br />203.04 <br />52.01 <br />.00 <br />2.285A2 <br />Sales <br />03/01l2023 - 03/31/2023 <br />06/01/2023 <br />2,261.74 <br />226.17 <br />30.04 <br />.00 <br />2,517.95 <br />Total <br />8,493.55 <br />sign <br />I certify that the Nebraska Department of Revenue has cornplree with tote laws of the State of Nebraska 'm determining tom amount shown to be the, <br />and that the taxpayer has laded to pay the amount due after demand. This Nouco of State Tax Len !s an effeettse lien and serves to continue the priority of <br />the State's intetost in the affected property dt tna taxpayer. <br />here Preps t re <br />prized Signature <br />Revenue Senior Agent 07/26/2023 . 402-595-2247 <br />Title hate Phone^-��y <br />Revenue Senior Agent F /4)444'• 74 r <br />Tile Date 44 <br />4-494-197c tev, a-2Gta Sup, rxvdes 4.949-'974 Rat,. 8.2C'3 <br />