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Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2015 <br />12/05/2016 <br />$435.00 <br />$21,75 <br />$20.41 <br />477.16 <br />. Individual <br />2016 <br />05/24/2017 <br />$72.00 <br />$3.60 <br />$1.22 <br />76.82 <br />Total <br />$553,98 <br />r� /vim <br />Nebraska Oepartmrtnt of <br />REVENUE <br />Vov.13. 2017 3:5)FM VE Secretary of State — UCC <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -460 <br />Notice of State Tax Lien <br />This Notice of State Tax Lien is issued by the Nebraska <br />Department of Revenue for unpaid taxes administered by the Tax <br />Commissioner. Taxes, including penalties, interest, and costs, <br />which are shown below, are due from the taxpayer and remain <br />unpaid after demand.These taxes are a lien for all property located <br />in the county and rights to property owned by the taxpayer or <br />acquired before the expiration of this Iien.This lien will expire and <br />become unenforceable 10 years after the date of recording if no <br />continuation statement is recorded on or prior to the expiration of <br />the previous lien or continuation statement. <br />Nebraska 1D Number <br />93581874 <br />Lien Serial Number <br />11797026 <br />sign <br />here <br />a <br />-r r <br />orize i natur <br />Uen Filed With: <br />Register of Deeds 0 County Clerk <br />Dale of Lien Lien Type: <br />November 07, 2017 J original 0 Continuation <br />Business Name and Location Address <br />t the Nab ka Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due. <br />xpayer ha to pay the amount due after demand. This Notice of State Tax Lien is an effective lien and serves to continue the priority of <br />erest in th aflemed property of the taxpayer. <br />Revenue Agent 11/07/2017 (308)632-1210 <br />Title Date Phone Number <br />Revenue Supervisor 11/07/2017 <br />Title <br />Federal ID Number <br />Social Security Number <br />XXX -XX -8801 <br />Corrected <br />$E Sec of Sias ]eh <br />9917581536 <br />MUHUPIED SUMQYA A <br />Filled: 11/13/2017 02:11 PM <br />PLEASE DO NOT WHITE IN THIS SPACE <br />201407751 <br />. <br />Spouse's Soctat SeCua y Number <br />County <br />HALL <br />Taxpayer Name and Mailing Address <br />SUMAYA A MUHUMED <br />527 N WHITE AVE <br />KANSAS CITY MO 64123 <br />Dale <br />4.494.1974 qaU 8-2013 9upan:ades 4.840 -1974 Rev. 2 -2002 . <br />