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Tax <br />Program <br />Tax Period <br />Date <br />Aaetiaa ° i <br />Tax <br />Penalty <br />Interest <br />Costa <br />Tafal Duo <br />Individual <br />2008 <br />12/0612011 <br />501.04 <br />25.05 <br />108.72 <br />634.81 <br />Total <br />3634.81 <br />Jan, 16. 2014 3:09PM NE Secretary of State — U00 <br />201400300 <br />Nebraska DepaPoment of <br />REVENUE <br />Nebraska ID Nanber <br />98690951 <br />Lien Swill Number <br />11427899 <br />Dee CAM <br />0111512014 <br />sign <br />here <br />Lien Type: <br />® Original <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, pro due from the taxpayer and remain <br />Unpaid after demsnd.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 IIen.T'hls Men will expire and <br />become unenforceable 10 years alter 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 />Lien Fled Wax <br />Replelar of Daedc ❑County Clerk <br />0Coninualion <br />PLEASE DO SOT WHITE INTHS SPACE <br />Federal ID Number <br />Sod el Seoutiv Number <br />XXX XX -1925 <br />°Congaed <br />SAMSON A KUOL <br />416 E SUTHERLAND ST APT 4 <br />GRAND ISLAND NE 68801 <br />No. 2372 P. 2/2 <br />le Soo of Slate John a Gala - Litt ei - <br />1 <br />9914725e <br />KUOI- Sn1WSON <br />Filed: ef/113/2e14 09:35 Iahl <br />Spouse's Sodal Seas* Number <br />County <br />HALL <br />!witty m t the Neheaska Departmental Revenue hes emceed TAM Pie lees of lie slated Nebaseke m delannIndsj the emote/ IlEme IO be did. <br />Me . " tided pry due otter derendT a Wake d Srle Tax Lien b. an shake ten and delves b MOM the pdorty d <br />Business Name and Location Address <br />er Name and Mailing Address <br />&I) /7 (402)471 -5731 <br />Phone Number <br />� <br />Oat <br />e -apR7p Rain MIS e 8 �goreeeee 441b4974 Res 22002 <br />