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202504474 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2508000539-8 Pages: 1 <br />Debtor Name: SUPEREMINENT HEALTH AND PERFORMANCE <br />Filing Date and Time: 08/12/2025 10:32 AM <br />Upon filing of this lien, and without <br />further notice, your property may <br />be seized to satisfy this lien. <br />N.EBRA644t r <br />tared Lie. Great Service <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 hen.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 00 NOT WRITE IN THIS SPACE <br />Nebraska ID Number Federal ID Number <br />14896508 873737781 <br />Lien Serial Number <br />12531010 <br />Lien Filed With: <br />® Register of <br />0countyCkr14 <br />Social Securay Number <br />NO SSN <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />Date d Lien <br />June I0,2025 <br />Lien Type: <br />®Original <br />ā¯‘Continuation <br />ā¯‘Corrected <br />County <br />HALL <br />Business Name and Location Address <br />axpayer Name <br />SUPEREMINENT HEALTH ANT) PERFORMANCE <br />404 E I I TH STREET <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 />Saba <br />01 /01/2022 - 12/31 /2022 <br />1 pf2O/2 %D <br />300.00 <br />60.00 <br />39.80 <br />.00 <br />399.80 <br />Saks <br />01/01/2023 - 12/31/2023 <br />((i.20/2021 <br />300.00 <br />60.00 <br />24.80 <br />.00 <br />384.80 <br />Total <br />784.60 <br />I cattily that the Nebraska Depanmenl of Re`eruc has complied with tM laws at the State of Nebraska it determining the amount shown to be due, <br />and that ate i.epayer has tailed to pay the amount due after demand. This Nonce of State Tax lien is an effective ken and sarane te continue the priority of <br />the State's interest n the a -. property of the taxpayer. <br />sign <br />here r PtepaeetkSigne <br />Authorized Signature <br />Revenue Agent <br />Title <br />Revenue Manager <br />Tate <br />06/03/2025 402-471-2518 <br />Date Phone Number <br />Date <br />449a.19ta Rex 62e1e rwpsredsa 44441974 Per. 62013 <br />