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Tax <br />Pmgram <br />Tax Period <br />Dale of <br />Aeseasrtaet <br />Tax <br />Penally <br />Interest <br />Coals <br />Thole[ Due <br />Individual <br />2011 • <br />1011312013 <br />521.00 <br />20.05 <br />37.61 • <br />564.66 <br />Total <br />$564.66 <br />t99 <br />Ma r, 27. 2014 1,55pM AL Secretary of State — UCC <br />Noma) p <br />REVENUE <br />Nebraska ID Number <br />06627174 <br />Lien Berke Number <br />11431435 <br />Rate of Yen <br />03/2112014 <br />sign <br />here <br />uen Fled Wit': <br />® R.glsler of E county Bair <br />Lien Type: <br />mod ❑ Condnuadon <br />Business Name and Location Address <br />Authorized <br />201401701 <br />Notice of State Tax Lien <br />This Notice of State Tax Llen Is leaned by the Nebraska <br />Department of Revenue for unpaid lazes administered by the Tax <br />Commissioner, Taxers, Including penalties, Interest and costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after dsmand.These taxes area !hinter 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 is hen will expire and <br />become unenforceable 10 years after the date of recordng if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien ofcontinuadon statement. <br />IL5AS5 DO NOT WHITE IN THIS SPACE <br />Federal ID Hurter <br />Social Seardty Number <br />XxX - Xx - 9195 <br />❑ Corrected <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 - 4609 <br />Manumit sonar Security Number <br />CoY <br />HALL <br />Taxpayer Name and *A IN N Address <br />AMINA DIRIYE <br />PO BOX 566 <br />GRAND ISLAND NE 66601 <br />No. 3971 °. 2 <br />Ne S.c of Marla Jahn it Baas - nl:C £TL <br />11111 lei � f <br />ICI, <br />9914732674 -4 P00 l 1 <br />RIRIVE nlINA <br />Filed: 03/27/7014 12:30 PM <br />f cerlay Iht the Nebraska Department of Revenue flea complied with the haw of the Stott of Nebraska Ie Oetermlairy he Mount shown to be due, <br />end Ihel dw WRVS hoe felled to pay the amount due.ker demand. This Nara of SWAG Tex lien Is en elfadive sen endgame') to oa*kwe Ma primly/ or <br />he news Nonni In he affect sty of Me taxpayer, <br />Revenue Agent 3-21—/y F 632.1203 <br />Date <br />14941974 Best 11•21313Supomades 49e$4174 Reg <br />MOM <br />