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N_ EBR A & 4A - <br />Good Lite. Greet Torvlce. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2202000094-9 Pages: 1 <br />Debtor Name: ALI AHMAD <br />Filing Date and Time: 02/02/2022 11:53 AM <br />Notice of State Tax Lien <br />202200887 <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 demend.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 lien.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 />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska ID Number <br />92266169 <br />Federal D Number <br />Lien Serial Number <br />12289730 <br />Lien Filed WM: <br />® Register Of Dews ❑ County as <br />Social Security Number <br />XXX -XX -3886 <br />Spouse's Social Security Number <br />Dale of Lion <br />January 25,2022 <br />r— <br />Lien Type: <br />®orginal El Continuation 0Correcled <br />County <br />HALL <br />usiness Name and Location Address <br />Taxpayer Name and Mailing Address <br />ALI AHMAD <br />604 SUTHERLAND ST APT 4 <br />GRAND ISLAND NE 68801 <br />Tax Program <br />Tax Period <br />Date of <br />Assessment <br />Tax <br />Penalty <br />Interest <br />Costs <br />Total Due <br />Individual <br />2019 <br />06/11/2021 <br />$1,274.00 <br />$345.85 <br />$70.33 <br />1,690.18 <br />Individual <br />2020 <br />06/11/2021 <br />$1,686.00 <br />$121.60 <br />$35.06 <br />1,842.66 <br />Total <br />$3,532.84 <br />sign <br />here <br />I certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determining the amount shown to be due, <br />and that the taxpayer has tailed to pay the amour due after demand. This Notice at State Tax Lion is an effective ken and serves to contaee the priority of <br />the State's Interest in the affected property of the taxpayer. <br />Revenue Agent 01/25/2022 (308)632-1208 <br />Preps Signature title Date Phone Number <br />Yrs Revenue Supervisor 01/25/2022 <br />ure Title <br />Date <br />4-.194.1974 Pe,. &201e Supersedes 4948.1974 Rev. 8.2013 <br />