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Progrem <br />Tex Period <br />Assessment Dale of <br />Tilt <br />Penalty <br />Interest <br />Costa <br />Thal Due <br />Indlvldual <br />2010 <br />04/08/2012 <br />763.00 <br />38.15 <br />106.76 <br />907.90 <br />1 <br />Total <br />$907.90 <br />Oct, 22, 2014 3:16PM NE Secretary of State — UCC <br />Nebieeke Qepm mart d <br />REVENUE <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid totes administered by the Tax <br />Commissioner. Taxes, induding penalties, interest, and costs, <br />which are shown below, are due from the taxpayer and remalri <br />unpaid after ddamend.Thesa 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 at this lienLThie 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 lien or continuation statement. <br />Nebraska D Number <br />96671262 <br />Lien Serial Nutter <br />11441755 <br />Date of Lien <br />1012112014 <br />sign <br />here <br />Business Name and Location Address <br />Slovene <br />Liver RbdWi9+: <br />® &Oster of Beads ❑ County Clerk <br />Use Type: <br />® ehi ❑ ConlInuall n <br />201406 18 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Federal ID Number <br />Social Security Number <br />)OOC - XX - 2801 <br />❑corresed <br />Taxpayer Name and Mailing Address <br />HUSSEIN A AHMED <br />710 14TH ST 5 APT 24 <br />SAINT CLOUD MN 56301 <br />Revenue Agent <br />NE 50m of Liar Jahn N Oat• • UCG 1TL <br />County <br />HALL <br />No 7267 P, 2 <br />99147431131-•6 Poe : I <br />pf�o <br />N Fti 2 <br />1 R <br />Fteed: i9f 12a14 ee:32 PM <br />Spousele Social Security Nunbe, <br />I certify lhei the NepaWre Oeperlmenl of Revenue hes complied wMh the laws of she Scala of Nebraska h deumtirwtg are amount shown to be du% <br />and that the Iespafrer has felled Io pay the amours dce after demand, TMs Nonce of State Tee lieu Is on effective war and Berms io conanue the Manly of <br />the ; 's interest in ; allecled property of the lattp7yse <br />Date <br />(402)471.5928 <br />Phan Number <br />Revenue Sup ervisor <br />rule Bete <br />4404.1$4 Bev. 64013 34er 4e4-1174 flat 24002 <br />