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t\IEBRAS-KA- <br />Good Life. Gant. Servi.e, <br />202304518 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2308000983-7 Pages: 1 <br />Debtor Name: FAITHFUL SOLUTIONS LLC <br />Filing Date and Time: 08/30/2023 09:58 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 Ilen.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 />11041234 <br />Federal ID Number <br />452480637 <br />Lien Serie! Number <br />12319028 <br />Lien Filed With: <br />® Register of Deeds ❑ County Clerk <br />social Security Number <br />NO SSN <br />Spouse's Social Secunly Number <br />NO SPOUSE SSN <br />Date of Lien <br />August 25, 2023 <br />Lien Type: <br />Q Original ❑Comtmuation ❑Corrected <br />County <br />HALL <br />Business Name and Location Address <br />axpayer Name and alautng Address <br />FAITHFUL SOLUTIONS LLC <br />D/B/A MONUMENT ADVISORS <br />PO BOX 398 <br />GRAND ISLAND NE 68802 <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 />04/01/2021 - 12/31/2021 <br />11/01/2022 <br />4,259.34 <br />3'71.17 <br />336.13 <br />.00 <br />4,966.64 <br />Sales <br />01/01/2022 - 10/31/2022 <br />01/03/2023 <br />6,424,33 <br />619.80 <br />306.38 <br />.00 <br />7,350.51 <br />Withholding <br />07/01/2021 - 12/31/2021 <br />11/10/2022 <br />1,887.69 <br />132.27 <br />110.64 <br />.00 <br />2,130.60 <br />Withholding <br />04/01/2022 - 09/30/2022 <br />02/24/2023 <br />557.52 <br />124.23 <br />22.83 <br />.00 <br />704.58 <br />Total <br />15,152.33 <br />sign <br />here <br />I cerdty that the Nebraska Department of Revenue has complied with the taws of the State of Nebraska In determining the amount shown to be due, <br />and that the taxpayer has failed to pay the amount due atter demand.This Notice of State Tax Lion is an effective Ilen and serves to continue the priority of <br />the State's Interest in the affected property of the taxpayer. <br />Preparers Signa Tide Date <br />Revenue Supervisor <br />Authorized S Title Date <br />4.4844e24 Pero. 8.2018 Supetsedoc 49494814 Ra, 8,2013 <br />Revenue Senior Agent <br />08/24/2023 402-471-5727 <br />Phone Number <br />8/24/2023 <br />