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Program <br />Tex Period <br />Dale al <br />Assessment <br />Tax <br />Remaly <br />Interest <br />Costa <br />ToIal Due <br />Individual <br />2009 <br />10/0212011 <br />401.00 <br />20.05 <br />71.10 <br />492.15 <br />Total <br />$482.10 <br />Jun. 2. 2414 3:19PM NE Secretary of State — UCC <br />NehhasYs Department <br />REVENUE <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid times administered by the Tax <br />Commissioner. Taxes, Including penalties, interest, and .costa, <br />' width are shown below, are due from the taxpayer and remain <br />unpaid after demand.These taxes are a lien for all property located <br />In the county and rights to properly owned by the taxpayer or <br />acquired before the expiration of this Iien.ThIs lien will expire and <br />become unenforceable 10 years after the date of recording if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous Ben or continuation statement. <br />Nebraska ID Number <br />97483397 <br />Lien Serial Number ' <br />11434498 <br />Dale of Lien <br />05/22/2014 <br />w <br />sig <br />here <br />Den Feed WO: <br />® Replaler lY Deeds °Cerny Clerk <br />Uen7ype; <br />®Oh' <br />Business Name and Location Address <br />Notice of State Tax Lien <br />0Cole cation <br />Federal D Nun# <br />PLEASE 00 NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Social Sway Nonber <br />XXX -XX -2937 <br />DCarracled <br />FUAD A FHASSAN <br />603EYUNDST <br />GRAND ISLAND NE 66801 <br />ME Esc W 64.k• ].0,n a Gate - UCC 57L <br />9915736541 -a p9=f 1 <br />Fi led 04/2014 11;70 AN <br />20140262 <br />Spoutl Sada1 SewMh number <br />County <br />HALL <br />Tsx*er Name and mailing Address <br />No. 5422 P. 2!5 <br />I certify that the Ne4rd olo Depe r1a nt a Reve ie has aompNed w h the Iran of the State at Nebraska In defexminnp Ike imam stow to be due, <br />Indira! lire rsextew has rased le pay nhe armed hire after demand. TNa Nolte elltale Tax LIen Is an Oaths tan ands rws le mean the pfa;f y of <br />the Stme'e Interest In <br />Revenue Agent <br />Tills <br />Revenue Supervisor <br />TAIe <br />308 <br />Phone <br />632 -1206 <br />«8F� }71 iex. eeZe188apaeeaes 48 1874 riar.g oo <br />