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NEBRA&KA- <br />Good Life. Great Service. <br />202304037 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2308000162-2 Pages: 1 <br />Debtor Name: BRITTANY LANAE JEPSEN <br />Filing Date and Time: 08/07/2023 09:27 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 WRRE IN THIS SPACE <br />Nebraska lD Number <br />12911445 <br />Federal V Number <br />820805357 <br />Lien Serial Number <br />/23/8464 <br />Lien flied YM8r1: <br />® Register et Deeds ❑county Clark <br />Social Security Number <br />XXX -XX -5957 <br />Sgoute'a Social Security Number <br />NO SPOUSE SSN <br />Date of lien <br />July 28, 2023 <br />Uen Noe: <br />02/01/2023 <br />2,504.63 <br />County <br />HALL <br />1/t onginal ©continuation <br />• Corractad <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />BRITTANY LANAE JEPSEN <br />BRITTANY'S <br />1775 WILLOW RD <br />SHELTON NE 68876 <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 />06/0112022 - 06/30/2022 <br />02/01/2023 <br />2,504.63 <br />250.46 <br />105.85 <br />.00 <br />2,860.94 <br />Sales <br />08/01/2022 - 10/3112022 <br />02/012023 <br />2,064.20 <br />175.53 <br />72.08 <br />.00 <br />2,311.81 <br />Sales <br />12101/2022 - 12/31/2022 <br />07/032023 <br />2,058.67 <br />205.87 <br />53.50 <br />.00 <br />2,318.04 <br />Sales <br />01/01/2023-01/31/2023 <br />07/03/2023 <br />616.63 <br />61.66 <br />13.35 <br />.00 <br />691.64 <br />Sales <br />02/01/2023 - 02/28/2023 <br />07/03/2023 <br />942.03 <br />94.20 <br />16.78 <br />.00 <br />1,053.01 <br />Sales <br />03/0112023 - 03/3112023 <br />07/03/2023 <br />492.80 <br />49.28 <br />6.68 <br />.00 <br />548.76 <br />Sales <br />04/01/2023 - 04/30/2023 <br />07/03/2023 <br />469.90 <br />46.99 <br />4.44 <br />.00 <br />521.33 <br />t 'astc Reduction <br />07/01/2019 - 06/30/2020 <br />12/14/2020 <br />25.00 <br />5.00 <br />2.57 <br />.00 <br />32.57 <br />Waste Reduction <br />07/012020 - 06/30/2021 <br />12/06/2021 <br />25.00 <br />5.00 <br />1.86 <br />.00 <br />31.86 <br />Waste Reduction <br />07/01/2021 - 06/30/2022 <br />12/142022 <br />25.00 <br />5.00 <br />.97 <br />.00 <br />30.97 <br />Total <br />10,400.93 <br />sign <br />here <br />0 <br />CO <br />t the <br />the Nebraska Department of Revenue has complied with the laws el the State of Nebraska in determining the amount atom to be dun. <br />pa , has tailed to pay the amount due after demand Thls Notice of State Tex Leen is an effective lien and servos to continue the priority of <br />S_ .: .:..w:'+•r ... yci the taxpayer. <br />rare Signature <br />Authorized <br />Revenue Agent 07/282023 402-471-5956 <br />Tide Date Phone Number <br />Revenue Senior Agent 07128/2023 <br />Tale <br />Date <br />44941974 ROK 6.2018 S uVaeeb 4949-+974 Per 8.2013 <br />