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10/16/2023 3:15:56 PM
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10/16/2023 3:15:56 PM
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202305430
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6-8 <br />NER, S44A.. <br />Li'f. (i est . _. <br />pg..,r..r a, x.V4114.. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2310000373-1 Pages: 1 <br />Debtor Name: HAVANA NIGHT LLC <br />Filing Daze and Time: 10/16/2023 10:36 AM <br />Notice of State Tax Lien <br />202305430 <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 />13683861 <br />Fedorat ID Number <br />843050962 <br />Social Security Numbe= <br />NO SSN <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />County <br />HALL <br />Lien Serial Number <br />12319376 <br />Lion Piled With: <br />® Register of Deeds El County Clerk <br />Date of wen <br />October 3, 2023 <br />Lien Type <br />❑Corrected <br />® Original 0Continuafian <br />Business Name and Location Address <br />axpayer Name and Mailing Adflrese <br />HAVANA NIGHT tIC <br />HAVANA NIGHT <br />106 14TH ST <br />GRAND ISLAND NE 66801 <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 />08/0112022 - 09/30/2022 <br />04/03/2023 <br />.00 <br />.00 <br />10.42 <br />.00 <br />10.42 <br />Sales <br />10101.2022 - 02/28/2023 <br />05/22/2023 <br />2,475./10 <br />495.(10 <br />85.50 <br />.00 <br />3,055.50 <br />Withholding <br />07101/2022-12/31/21022 <br />05`2212023 <br />990.00 <br />272.25 <br />37.79 <br />.00 <br />1,300.04 <br />Total <br />4,365.96 <br />1 certify that the Nebraska Department of Revenue has comped with the laws of the Stale of Nebrastta in determining the amount shown to be due. <br />and that the taxpayer has failed to pay the amount char after denvsnd. This Notice of State Tax Lien is an effective Sen and serves to continue the priority of <br />the State's interest In the attested property of the taxpayer. <br />sign <br />here <br />tioc-ca, t[/iL�tTA9Pr{ ll+• <br />Revenue Agent <br />wee.; Sign <br />C sr <br />Authorized Signeture <br />09/29/2023 402-471-5717 <br />ittle <br />Revenue Supervisor <br />Date Phone Number <br />ik 44 9e <br />Title Dale <br />4-494-95:4 5ev. h-llsle &140r5Otlas 44i4a.'e74 Rev a 2013 <br />
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