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12/10/2009 THU 8:12 FAX 402 471 4429 UCC SECRIBTARY OF STATE ~~~ Hdll <br /> <br />2oosossso <br />Please return Copy to: <br />Nebraska Dept of Revenue <br />PO Box 94818 . <br />Lincoln NE 68509 <br />-- Ne~br~aska Department of <br />~EVE~VUE <br />www.revenue.ne.gpv <br /> PLEASE DO NDT WRI IN TMIS SPACE <br />This Notice of State Tax Lien is issued by the Nebraska Department of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Nntice is hereby given that taxes including penalties and <br />interest, which are shown below, are due from the taxpayer specified <br />below and remain unpaid after demand. These taxes constitute a lien <br />in the county for real and personal property belonging to the taxpayer <br />or hereafter ac uired. <br />Nebraska Idenliflcafion Number Federal Identification Number <br />98696602 <br />Lien Serial Number Lien Filed With 5odal Security Numtrer Spouse's Sacial Security Number <br />10933392 ®Register of Deeds ~Caunty Clerk XXX-XX-5736 <br />Dale of Lien Lien Type County <br />12/04/2D09 ®Original ~ContinuatianCorrected HALL <br />BUSINESS NAME AND LpCA TION ADDRE55 TAXPAYER NAME AND MAILING AODRt:55 <br /> SAID ADEN <br /> 302D S 154TH ST APT 138A <br /> SEATAC WA 98188-4117 <br />Tax <br />Category Tax Prrlod Date of Amount of lax Penalty Interest Additions Balanee of <br />Number Assessment Assessment Due <br />22 2005 07/29/2008 228.00 11.40 56.83 296.23 <br /> <br /> <br /> <br /> <br /> TOTAL $ 296.23 <br />1 hereby certif y that the Nebras ka Department of Revenue has comolied with the revenue laws of the Slate of Nebraska m the determination of the <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of State Tax Lien is an extension of an <br />effective lien, it serves to continue the priority of th fate's interest in the affected property of the taxpayer. <br />nue Agent 12104!2009 (402)471-5928 <br />SI~II Prep re s Si ore le pale elephone Number <br />here / Reven_u_e Supervisor 12/04/2009 <br />Authorized Signature Title TT ~ Date <br />4.494.1974 Rev. 2.2uU2 Supersedes 4-494.1974 Rev. 10-1595 <br />~oo3/no7 <br />NE Sec of S!s!e John, q Gete <br />- UCC 57L <br />9909633635-3 Pgs: 1 <br />ADL=N 5gIp <br />Filed: 12/08/2009 12:50 PM <br />NOTICE OF STATE TAX LIEN <br />v <br />