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P �9 <br />Tax Period <br />Amassment <br />Tax <br />Penalty <br />interest <br />Costs <br />Total Due <br />Individual <br />2011 <br />03/28/2013 <br />371.00 <br />18.55 <br />31.14 <br />420.69 <br />Total <br />$420.69 <br />ug. 13. 2014 3: 13PM NE Secretary of State — UCC No. 6165 P. 2 <br />Nebraska Depirenert <br />REVENUE <br />Nebraska ID Number <br />95761829 <br />Lien Sedal Number <br />11438008 <br />Dale of am <br />08/11/2014 <br />Business Name and Location Address <br />201405013 <br />Notice of State Tax Lien <br />This Notice of State Tax Lien Is Issued by the Nebraska <br />Department of Revenla3 for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including penalties, interest, and costs, <br />Which are shown below, are due from the taxpayer and remain <br />unpaid after demand.These taxes are a lien for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this Tien. This lien will expire and <br />become unenforceable 10 years after the date of recording If no <br />continuation statement is recorded on or prior W the expiration of <br />the previous Ilan or continuation statement. <br />Tic <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID number <br />Na 1 <br />9514744371 -6 Pga: 1 <br />PLI FAT1�$ <br />Fl lad: t1t111312014 11 :02 AM <br />Social Sectolty Number <br />XXX•065056 <br />Llen FNed WYh! <br />® Regielar of Deeds ❑ County Palk <br />lien Type: Cc'mly <br />50 NO rat 0 Continualoe ❑Co rested HALL <br />FATAH AU <br />616 SUTHERLAND ST APT 2 <br />GRAND ISLAND NE 68801 <br />Spouse's Social Seelrity Number <br />Taxpayer Name and Mailing Address <br />I certify that the Nebraska Department of Pevenue has corralled NNh the laws of me Slate at Warman h determining the amour shun to be due, <br />and Nxe1 the taxpe Ter hex failed to pay the rareenl due after demand.lhis Neat* d Slate Tax Lien k an effective Nan and eervee b coolttue Pte pricey of <br />the Staie'a interest in the Properly ar the lexPeyer. <br />Revenue Anent 8 / 1402)471 5789 <br />T as Data Prone Nurnber <br />Revenue Supervisor <br />Dale <br />4-491 -1974 Mr. ISM 1a3Qeredes4440071 Ra s <br />