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INI <br />Program <br />Period <br />Date of <br />Assessment <br />1511 <br />Penally <br />Interest <br />Costs <br />Total Due <br />Individual <br />2011 <br />09/27/2013 <br />440.47 <br />22.10 <br />37.48 <br />500.03 <br />lbtal <br />$500.03 <br />Aug, 25, 2014 2:22PM NE Secretary of State — ()CC <br />201405226 <br />Nebraska Daen,fma t of <br />REVENUE <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, are due from the taxpayer and remain <br />unpaid after demand.These taxes am a lien for all properly located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this lien.Thla 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 d <br />the previous lien or continuation statement. <br />%vests ID Number <br />96959282 <br />Lien Sara) Narnber <br />11438602 <br />Dare" <br />Uen Fled Mrs <br />Register of Deeds ❑ aunty cleat <br />Uen Type: <br />061Z112014 Cg] iJd ❑ conrnuattm <br />Business Name and Location Address <br />Notice of State Tax Lien <br />PLEASE no HOT WRITE INTHIS SPACE <br />Federal 10 N%Faber <br />SoderSeemiy Number <br />XXX - XX -4638 <br />Spouse's Sodel Security Numdx <br />County <br />� Consisted HALL <br />1' er Name and Malin Add <br />No. 6335 P. 2/2 <br />°a IT <br />ME nd .f l4.1. SEN., sal■ U0 L 1'. V.. <br />l ' II <br />9314744675 -4 Pe!: <br />JP1IA iIEYKPL <br />Fllexl: fpf2512514 10.41 RI1 <br />Sign <br />here <br />I certify that the Nebraska Detachment of Remelt has complied win the have of the Silo d Nebredw In detem*enq the mewl shown lobe due, <br />and that the taxpayer Iva laced to pay Iv amount due slier demand. This Noticed Slate Tax %Jen Is en eriselhe ten and term to cords a the pdoray of <br />Ile State's ideas* in 1 anima progeny of me tomes. <br />Signature <br />HEYKAL JAMA <br />PO BOX 457 <br />GRAND ISLAND NE 68801 <br />Revenue Agent <br />This <br />Revenue Supervisor <br />This <br />1 (402)471 -6043 <br />Phone Number <br />Dale <br />4 - t4974 RW &t918&persege #lW-0f4rter.2,2002 <br />