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NERRAG4sA <br />Good Lie. Great service. <br />on•MTx,erw eerawr <br />NE Sec of State - Robert 2vi <br />Filing Document #: 2307000633-6 Pages: 1 <br />Debtor Name: ABDI 0 JAMA <br />Filing Date and Time: 07/21/2023 10:34 AM <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 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 WRIT pi THIS SPACE <br />Nebraska ID Number <br />93923074 <br />Federal ID Number <br />NO FEIN <br />Lien Serial Number <br />12339672 <br />Ven Flied With: <br />Social Security Number <br />XXX -XX -1702 <br />Spouse's Social Security Number <br />NO SPOUSE SSN <br />®r}egislet of Deeds • County Clerk <br />Date of Lien <br />July 18, 2023 <br />Len Type: <br />❑Corrected <br />Coulmy <br />HALL <br />Original ❑Continuation <br />ocation Address <br />Taxpayer Name and Mailing Address <br />ABDI 0 JAMA <br />2222 BELLWOOD DRIVE APT 51 <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 />2021 <br />11/04/2022 <br />$1,063.00 <br />$62.56 <br />$51.69 <br />$1,177.25 <br />Total <br />$1,177.25 <br />sign <br />here <br />I certify that the Nebraska Department of Bavernue has complied with the pews of the Stale of Nebraska in determining the amount shown to be due. <br />and that the taxpayer has tailed to pay the amount due aper demand. This Notice of State Tax tJen Is an effective lien end serves to continue the priority of <br />the State§ Interest in the affected property of the taxpayer. <br />Preparer's Signature <br />homed Signa <br />Revenue Agent <br />Tide <br />Revenue Supervisor <br />07/18/2023 (402)471-6043 <br />Date Phone Number <br />07/18/2023 <br />Title Date <br />4494.1574 Ree $.pate Supersedes 4-949-1974 Bare 5-2013 <br />