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Good Lde. Great Service. <br />202304803 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2309000284-2 Pages: 1 <br />Debtor Name: BROCK CULLER <br />Filing Date and Time: 09/14/2023 11:45 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 Iien.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 />12904252 <br />Federal ID Number <br />820983943 <br />Lien Serial Number <br />12318965 <br />Lien Filed With; <br />IN Register of Deeds 0 County Clerk <br />Social Security Number <br />XXX -XX -0386 <br />Spouse's Social Security Number <br />XXX -XX -4574 <br />Dale of Lien <br />August 30, 2023 <br />Lien Type: <br />xi Original ❑Continuation ❑Corrected <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />BROCK & JESSICA CULLER <br />D/B/A 4M CLEANING LLC <br />1014 SOUTH PLUM <br />GRAND ISLAND NE 68801 <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 />02/0112019 - 09:30/2021 <br />03/14/2023 <br />53,373.96 <br />7,305.56 <br />6,396.58 <br />.00 <br />67,076.10 <br />Withholding <br />07/01/2019-09/30/2021 <br />03/14/2023 <br />6,009.02 <br />1,145.94 <br />565.27 <br />.00 <br />7,720.23 <br />Total <br />74,796.33 <br />I certify that the Nebraska Department of Revenue hes compiled with the laws of the State of Nebraska In determining the amount shown to be due. <br />and that the taxpayer hart failed 10 pay the amount due atter demand. This Notice of State Tax Lien Is an deathve lien end serves to continue the priority of <br />the State's interest in the affected property of the taxpayer. <br />sign stew_ W'a4r -/ etc <br />here Preparers Sy are <br />Authorized ignature <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />09/06/2023 402-471-5717 <br />Date <br />Phone Number <br />9/6/2023 <br />T� Date <br />4.4944974 Ree 8-2018 Supersedes 44949.1974 Ran 5.2013 <br />