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Program <br />Tax Period <br />Tali <br />A Penalty <br />lehreut <br />Costs <br />Total Dee <br />Individual <br />2009 <br />07100/2012 <br />520.00 <br />26.00 <br />92.82 <br />638.82 <br />• <br />T4taI <br />$638.82 <br />Jun. b. 2014 1:55PM NE Secretary of State — JCC <br />1iaMwla Oerlarumre of <br />REVENUE <br />This Notice of State Tax Lien Is issued by the Nebrea a <br />Department of Revenue for unpaid taxes administered by thebi <br />Commissioner. Taxes, including penalties, Interest, and costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demend.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 Me expiration of this lien.This lien will expire and <br />become unenforceable 10 years alter the date of recording if no <br />continua lion statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement <br />Nebreeke ID Number <br />97568279 <br />lien Sedei Number <br />11435045 <br />Date ax Lien <br />06104/2014 <br />sign omm <br />here <br />Business Name and vocation Address <br />Ware <br />Lien Red rrlh: <br />® Register at Deeds CI CDult/Cleft <br />Lien Tape: <br />® orddld <br />Notice of State Tax Lien <br />❑Dare ueem ❑comma <br />TIIe <br />PLEASE DO NOT WRITE IN MI5 SPACE <br />Faded Id Number <br />Said Sew* Netter <br />XXX40C -6360 <br />NASRAIMOHAMUD <br />2222 t3ELLWOOD DR APT 102 <br />GRAND ISLAND NE 68801 <br />No.5250 1 4 0 3 3 68 <br />IC Std S4 a4 Mt A Asia - I.CC STL <br />9814737523 -4 pee: 1 <br />MONAIID NPSRR I <br />Filed: 06/26/2814 1045 R11 <br />SpoUSe. Social Security Nun er <br />Cana <br />HALL <br />Taxpayer Name and Nailing Address <br />eerNA t i the Nebrata Oeowti ler4 d Aevanue Me coed a iar tie lam d dui Slab el Nabwulos iA delaVminirg e,. amount m b <br />and that the taxpayer has talletl to pay ma maw dug alley demand. Thla Iofce of Stale Tax lien It an affective Ian and terve310 iutiu a the priority d <br />3 30% Interest In the albaad papery of the ems. <br />Revenue AQent 6 ) 4 1 <br />Tee Dale <br />Revenue Supervisor <br />(402)471 -5712 <br />Phone Nunft <br />6.7+ <br />Dam <br />....•..T. wM cacti e.pw.wr 4.4• w.. raaoe <br />ciP <br />