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PrngrXam Tax Period Ass�ea1esmont Tax Penalty Interest Costs Total Due Individual 2012 07/01/2014 534.00 26.70 52.62 613.32 Total $613.32 Jul. 29. 2016 3:23FM NE Secretary of State — UCC Nebrwka DspartmenY or 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 lien. 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. Nebrestq IQ Number 96567678 Lien Serial Number 11674910 Date of Licit 07/27/2016 sign here Business Name and Location Address I Gerrity hal the t_ f ate's In Authorized Signature Notice of State Tax Lien Lien Flied 1MIIft ® Register of Deeds fl County Clerk Lien Type: PLEASE DO NOT WRITE IN THIS SPACE Federal ID Number Social Security Number XXX -XX -2326 Oflglnal 0 Continuation ❑ Corrected County HALL Spouse's Social Security Number Taxpayer Name and Mailing Address ABDIWELI BARE 608 SOUTH EDDY GRAND ISLAND NE 68801 Pr rs Signature Revenue Agent Tide Revenue Supervisor Title 204650.4873 : NI Gee of Bois John 2 Oslo - LCC 5TL 9918777632 -7 Pas: 1 BARE RBDIWELI Filed: 07/29/2016 09:05 AN Neb : : Depa . of Revenue has complied with the Iews of the State of Nebraska in determining the amount shown to be due, d to pay , :. amourd due altar demand. This Notice of Slate Tax Lien is an effective lien and serves to continue the priority of ed pro the taxpayer. 'Apr 07/27/2016 (402)471 -5731 Date Phone Number 07/27/2016 Dale 4- 494-1970 Rev. 94019 Supersemee 4949.1974 MK 2-2902