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NEBRASKA - <br />Good t.ir.. Great Service. <br />mwsirhotoe •••41101011 <br />202400348 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2401000687-2 Pages: 1 <br />Debtor Name: DOUBLE LINE AUTO REPAIR LLC <br />Filing Date and Time: 01/24/2024 08:57 AM <br />Notice of State Tax Lien <br />This Notice of State Tax Lien la 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 des from the taxpayer and remain <br />unpaid atter demand.These taxes area lien for ail 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 />PLEASED° NOT WRITE MINIS SPACE <br />N�braskd Ib tVctm4rr - <br />14001519 <br />IO Number <br />852213851 <br />Lien SaW Number <br />12321210 <br />Llan Ford tM h: <br />IS] rmuciraDeeds 0CounsyCleric <br />SocW Security Number <br />NO SSN <br />Spouses Salk Security Number <br />NO SPOUSE SSN <br />Oats of Lien <br />January 4, 2024 <br />Liao Type: <br />0 Ca»cted <br />County <br />HALL <br />1;/ Original 0 Cortinuasan <br />Business Nero and Location Address <br />Taxpayer Mame and Mailing <br />DOUBLE LINE AUTO REPAIR LLC <br />3700 WEST 2ND STREET <br />GRAND ISLAND NE 68801 <br />Tax Program <br />1 <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Sales <br />11/01/2022 - 11/30/2022 <br />04/16/2023 <br />3,390.00 <br />678.00 <br />174.44 <br />.00 <br />4,242.44 <br />Sales <br />12/01/2022- 12/31/2022 <br />04/16/2023 <br />3,390.00 <br />678,00 <br />162.08 <br />.00 <br />4,230.08 <br />Sales <br />01/01/2023 - 01/31/2023 <br />08/28/2023 <br />3,730.00 <br />746.00 <br />162.48 <br />.00 <br />4,638.48 <br />Sales <br />02/01/2023 - 02/.28/2023 <br />08/28/2023 <br />3,730.00 <br />746.00 <br />148.18 <br />.00 <br />4,624.18 <br />Sales <br />03/01/2023 - 03/31/2023 <br />08/28/2023 <br />1,865.00 <br />373.00 <br />66.17 <br />.00 <br />2,304.17 <br />Tire Fee <br />01/01/2021 - 12/31/2021 <br />07/09/2022 <br />50.00 <br />30.00 <br />3.92 <br />.00 <br />83.92 <br />Tire Fee <br />01/01/2022 -12/31/2022 <br />08/28/2023 <br />.00 <br />25.00 <br />.00 <br />.00 <br />25.00 <br />Waste Reduction <br />07/01/2021 - 06/30/2022 <br />12/14/2022 <br />24.97 <br />5.00 <br />1.47 <br />.00r <br />31.44 <br />Total <br />20,179.71 <br />certify neral the Nebraska Department at Revenue has complied nth an SINS at se same of NWruia h detente/Mg the amount /lawn to be due. <br />and shat the nxpeyer has Palled b pay the macs due afar dsn,sIad.This Notice of Stale Ax Lim Is en Medi Ion and serum b oarriaua ea priority at <br />the Slaters interest in Me elected properly at ere lexpeyer. <br />sign#447/41.40.t. <br />here��e <br />Revenue Senior Agent <br />Tide <br />Revenue Supervisor <br />Tate <br />12/28/2023 402-471-067 <br />Dan <br />Phone Number <br />1/22/2024 <br />Dan <br />4454.w 74 hoe a.IItba Sucenostist 4 -eta -Ism ileus -5013 <br />