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iEBRC7^c.SKA— <br />Gcod Lite.: meat 0e+rce. <br />�Or 04684 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2309000118-0 Pages: 1 <br />Debtor Name: PAM EHLERS <br />Filing Date and Time 09/08/2023 09:31. 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 al! property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this Iien.This Tien 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 Ilen or continuation statement. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraake ID Number <br />7251076 <br />Federal ID Number <br />470784697 <br />Lle n Serial Number <br />12318895 <br />l.lers l=•%edwilh: <br />® Register of Deede Qcoirmy Berk <br />Social Security Number <br />XXX -XX -2200 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Date of Lien <br />August 25, 2023 <br />Lien Type: <br />® Original OCornhmtation 0ax,et:ked <br />County <br />HALL <br />Business Name and Location Address <br />axpayer Name anct taaning AQtlrests <br />PAM El ILERS <br />D/B/A FOURTH STREET CAFE INC <br />2107 N MONITOR RD <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 />04/01/2019-09/30/2022 <br />05/02/2023 <br />21,668.12 <br />6,513.30 <br />2,749.62 <br />.00 <br />30,931.04 <br />Waste Reduction <br />07/01/2020 - 06/30/2022 <br />05/02/2023 <br />50.00 <br />10.00 <br />2.86 <br />.00 <br />62.86 <br />Total <br />30,993.90 <br />1 certify Mat the Nebraska Department of Revenue has compiled with the laws 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 after demand. This Notice of State Tax Lien is an effective Nen and serves to continue the priority of <br />the State's interest In the affected property of the taxpayer. <br />sign044 ,1, �a - <br />here ► thaparer'sS7rant <br />: <br />Authori' Signature <br />Revenue Agent <br />Tete <br />Revenue Supervisor <br />09/01/2023 402-471-5717 <br />Date <br />Phone Number <br />9/5/2023 <br />Mee Dae <br />4494.1934 Ron. 8.2018 Supetseeea 4.949.1974 fie%8 2013 <br />