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Tax Program Tax Period Date of Assessment Tax Penalty Interest Costs Total Due Individual 2011 11/16/2614 196.00 9.80 27.32 233.12 Total $233.12 .tun, 20. 2:116 3:18PM NE Secretary .nf State — UCC Na. 7026 P. PLEASE RETURN TO: NEBRASKA DEPT OF REVENUE PO BOX 94609 LINCOLN NE 68509 -4609 Nebraska Dipanmenl 01 REVENUE This Notice of State Tax Lien Is issued by the Nebraska Department of Revenue for unpaid taxes administered by the Tax Commissioner, Taxes, including penalties, Interest, and costs, which are shown below, are due from the taxpayer and remain unpaid after demand.These taxes are a lien for all property located In the county and rights to property owned by the taxpayer or acquired before the expiration of this iien.This lien will expire and become unenforceable 10 years after the date of recording if no continuation statement is recorded on or prior to the expiration of the previous lien or continuation statement. Nebraska ID Number 96307134 Lien Serial Number 11673164 Date of Lien 06/16/2016 Sign here and the Lien Filed With: ® Register of Deeds D County Clerk Business Name and Location Address Icen Authorized Signature Tide 201603801 Notice of State Tax Lien PLEASE DO NOT WRITE IN THIS SPACE Federal ID Number Social Security Number XXX -XX -8962 Lien Type: ® Original Continuation 0Corrected Taxpayer Name and Mailin Address ZAKARIA F GANGRA AZIZA 0 ALGA 2314 W GEORGE APT 1 GRAND ISLAND NE 66803 Revenue Agent we 5oe of 5tis4 Joh.. S 0.18 - UCC STL 8916775654 -1 Pgs: 1 GANGRA =RKRRIP F Filed: 06/201201 02:01 PM Spouse's Social Security Number XXX -XX -7287 County HALL rd of Revenue has complied with the laws of the Slate of Nebraska In determining the amount shown to be due, the amount due elver demand. This Nolte of Slane Tax lien is an &leaave lien and Serves to Continue the priority of of the Taxpayer. 06/16/2016 (308)632 -1210 TiIle Date Phone Number Revenue Supervisor 06/16/2016 Dale 4494 -1971 Rev. B-2019 Sw eriieoea 4- 5i91974 9ev. 2-2002