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09/20/2012 THU 13:41 FAX 402 471 4429 UCC SECRETARY OF STATE -�-+� Hall <br />� <br />� � <br />� <br />@looz/ooz <br />N Oela - UCC SR <br />Pgs: 1 <br />WRRSRME OSMIRN R <br />Flled: 0.9/2�/2g12 09:36 RM <br />�- � <br />Nebraska.Department of <br />. RE�N��E NOTICE OF STATE TAX LIEN <br />w,�,� � e. � e.a <br />This Notice of State Tax Lien is issued by the Nebraska Depar�nent of <br />Revenue for unpald taxes pursuant to the revenue laws of the state of <br />Nebraska. Nottce is hereby given that t�xes including penalbes and <br />interest, which are shown below, are due from the �cpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter acauired. <br />97920673 <br />NEBRASKA DEPT OF REVENUE <br />1313 FARNAM-ON-THE-MALL <br />OMAHA NE 68102-1871 <br />ucr�.�w�arvuiwa -- L16I1t11WdYllfl SOC181SeqfflljlNURIb2f SpOUSE'SSOfA815 <br />11298218 �Register of Deeds �Cflunty Gerk XXX-XX-2954 <br />Date oF Lien • .. Lien TyPe County <br />09/18/2012 ia .. �Orlgir�l �Continuadon �CoRected HALL <br />BUSINESS�NAME AND LO�ATION ADDRESS TAXPAYER NAME AND MAILING ADDRES3 <br />� <br />°• OSMAN A WARSAME <br />3550 W SAINT GERMAIN ST APT 112 <br />" SAINT CL�UD MN 56301 <br />Tax _ <br />Category Tax PeHod Date of <br />Number Assessme� <br />22 2009 1 Q/15%2011 <br />:� <br />, <br />Amount of Tax Penalty <br />231.00 11.55 <br />Interest I AddiGons <br />28.03 <br />TOTAL <br />2�o.sa <br />���o� ��r � u�y u �a� ��e Ka uep � or Kevenue nas compue0 w�tn the revenue laws of the 5tate oF Nebraska in the determinaGon of the <br />amount shown to . ue, the ye,r failed to pay the amount due after demand. If this Notice of State Tex Lien is an e�dension of an <br />effective lien, it to u state's fnt�t in the affeded property of the tar�ayer. <br />� Revenue Agent � � ( �'' � (308}632-1210 <br />sign P Ti e Date I�hw�e Number ' <br />. '�n�a <br />here .�- � Revenue Supervisor � � � � � � �— <br />A ignature 7itle Date <br />4494-1974 Rev.2•2002 Supersedas 4-494-1974 Rex 10-1895 <br />Balance of <br />sessment Due <br />270.58 <br />i <br />i <br />( V,� <br />� <br />