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This Notice of State Tax Lien is issued by the Nebraska Revenue for unpaid taxes pursuant to the revenue laws Nebraska. Notice Is hereby given that taxes including penalties interest, which are shown below, are due from the taxpayer below and remain unpaid after demand. These taxes constitute in the county for real and personal property belonging or hereafter acquired. Department of of the state of and specified a lien to the taxpayer PLEASE 00 NOT WRITE IN THIS SPACE Nebraska Identification Number 99799901 Federal Identification Number Lien Sena! R^ : 11311082 ¢C ]Register i Ih County Cleric Social Security Number XXX -XX -8892 Spouse's Social =- t/ `umber at Deeds II Date of UeA 0926/2013 Uen Type fed County HALL a Original ■ Continuation U Cane BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAIUNG ADDRESS • _ , JACOB N JAMES 3344 MANDERSON ST OMAHA NE 68111 Tax Category Number Tax Parted Data of Assessment Amount of Tax Penalty , Interest . Balance of Assessment Due 22 2009 02/08/2012 732.00 36.60 115.56 884.16 TOTAL $ 864.16 I hereby certify that the Nebraska Deparbbirent . Revenue has complied with the revenue laws of the State of n the determinably' of nip Sep. 30. 2013 3:10PM NE Secretary of State — UCC 11111111111 111. Nebraska 'Department REVENUE N!w w. rev. n u,, h e.e. sign here • Revenue Agent Title Revenue Supervisor rue 201307980 9913723492 -9 .JRMES JACOB N Filed: 00)30/2813 PLEASE RETURN TO: NEBRASKA DEPT OF REVENUE PO BOX 94609 LINCOLN NE 68509 -4609 NOTICE OF STATE TAX LIEN amount AMR) to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an effective Yen, It eaves to continue the • ' 'ty of the state's interest in the affected property of Ma taxpayer.