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This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer 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 acquired. <br />PLEASE DO NOT WRITE IN THIS st'AC.t <br />Nebraska Identification Number <br />98030108 <br />Federal Identification Number <br />Security Number <br />Lien Serial Number <br />11211383 <br />Lien Filed-With <br />Register of Deeds II County Clerk <br />Soda) Security Number <br />XXX - XX - 7029 <br />Spouse's Social <br />Date of Lien <br />12/27/2012 <br />Lien Type <br />�!'l Original 1 Continuation 111 Corrected <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />JEYLANI GEDOW <br />419 CEDAR AVE S APT 6413 <br />MINNEAPOLIS MN 55454 <br />Tax <br />Category <br />Number <br />Tax Period <br />Date of <br />Assessment <br />Amount of Tax <br />Penalty <br />Interest <br />Additions <br />As Balance <br />Due <br />22 <br />2009 <br />10/31/2010 <br />368.43 <br />21.45 <br />55.81 <br />445.69 <br />TOTAL <br />determination <br />$ 445.69 <br />the <br />1 herehv certify that the Nebraska Department o Revenue has complied with the revenue laws of the State of Nebraska in the l o <br />12/31/2012 MON 12:56 FAX 402 471 4429 UCC SECRETARY OF STATE <br />here ■ <br />A <br />ed Sig <br />Title <br />Hall <br />J E Sec of S ate John <br />11 111 <br />9912705571 -3 <br />GEDOW JEYLRNI <br />Filed: 12/31/2012 12:16 PM <br />PLEASE RE. <br />NEBRASKA DEPT OF REVENUE <br />1313 FARNAM -ON- THE - MALL <br />OMAHA NE 68102 -1871 <br />201211234 <br />Nebraska Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.. rave rl u e. n e. g oV <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand- rt mrs r ouce or aJale J J7R <br />effective lien, it serves to continue the priority of the state's interest in the affected property of the taxpayer. <br />, Revenue Agent <br />s �� Title <br />Revenue Supervisor Date <br />Date <br />4- 494.1974 Rev. 2 -2002 Supersedes 4.494 -1974 Rev. 10.1995 <br />/006/006 <br />ft Gale - UC 58. <br />P9s 1 <br />(308)632 -1203 <br />Telephone umber <br />2- 7 v <br />