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N <br />Good Life. Great Service. <br />DIMETQMT Of EEVENUI <br />Notice of State Tax Lien <br />202601298 <br />Nebraska Secretary of State <br />-FILED- <br />File #: 2603049827-8 <br />Date Filed: 3/4/2026 9:48 AM <br />C0521-4554 03/04/2026 8:17 <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 Ilen or continuation statement. <br />PLEASE DO NOT WRITE IN THIS SPACE N <br />a <br />C• <br />m <br />a <br />K <br />m <br />t7 <br />n <br />m <br />Nebraska ID Number <br />98102087 <br />Federal ID Number A- <br />fu <br />NO FEIN <br />Lien Serial Number <br />12622291 <br />Lien Filed With: <br />® Register of Deeds III County Clerk <br />Social Security Number <br />XXX-XX-9191 <br />Spouse's Social Security Number OD <br />NO SPOUSE SSN ri <br />Date of Uen <br />January 22, 2026 <br />Lien Type: <br />Corrected <br />County tD <br />rr <br />HALL N <br />K <br />4 Original III Continuation <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />FUAD HIRSI <br />2222 BELLWOOD DR APT 102 <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 />2022 <br />06/13/2023 <br />$.00 <br />$.00 <br />$15.77 <br />$15.77 <br />Individual <br />2024 <br />10/31/2025 <br />$2,390.00 <br />$119.50 <br />$147.72 <br />$2,657.22 <br />Total <br />$2,672.99 <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 failed 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 />the State's interest in the affected property of the taxpayer. <br />sign <br />here 0 Preparer's Signature <br />Authorized Signature <br />Revenue Manager <br />Title <br />Revenue Supervisor <br />Title <br />01/22/2026 (402)471-5729 <br />Date Phone Number <br />01/22/2026 <br />Date <br />4-494-1974 Rev. 8-2018 Supersedes 4-949-1974 Rev. 8-2013 <br />0 <br />rn <br />rt <br />w <br />rt <br />m <br />