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01/21/2010 THU 15:18 FAX 402 471 4429 UCC 58CRETAItY pF STATI; yyy Hall <br /> <br />24~ooo4ss <br />0003/005 <br />NE Sra K fkrk^ Jahn p dalr - U[G STL <br />9910637488-3 PoS: 1 <br />FARAH ALI M <br />Filed: 01!21!2010 09:42 AM <br />Nebraska Department of <br />REVENUE NOTICE OF STATE TAX LIEN <br />www.reven ue.n®.gov <br /> PLEASE DO NQT WRITE 1N~7H 5 SPACE= <br />This Notice of State Tax Lien is issued by the Nebraska pepartment of <br />Revenue for unpaid taxes pursuant to the revenue laws of the state of <br />Nebraska. Notice 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 of red. <br />Nebraska Identification um r ederal Identi ication Number <br />97990485 <br />Lien erial Number Lien Filed With Social Secunty Number Spouse's Sxial ecumy Number . <br />11034973 ®Regisier of Deeds County Clerk XXX-XX-0406 <br />pate o Lien Lien ype my <br />01/15/2010 ®Original Continuation ~Correded HALL <br />BUSINESS NAMI: ANO LOCAT ION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> ALI M FARAH <br /> 1615 S 4TH ST APT M2510 <br /> MINNEAPOLIS MN 55454-7748 <br />Tax <br />Category <br />Number Tax Parlod Date of <br />Assessment Amount of Tax E>enalty Interest Addifjons Balance of <br />Assessment Due <br />22 2007 02/05/2009 285.00 14.25 31.01 330.26 <br /> <br /> Please return Copy to: <br /> <br /> Nebraska Dept of Revenue <br /> PQ Box 94818 <br /> Lincoln NE 68509 <br /> TOTAL $ 330.26 <br />I hereby certif y that the Nebraska Deaartment of Revenue has camniia~f wi sh the rp~pn~.p ia~.,~ „f -hp ct~ro ~r d,.~er~ ;., rtie ae ~e.,.,~,..,~,.... ,.r ~~... <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Nalice of State lax Lien is an extension of an <br />effective lien, it serv to continue the priority of the state's interest in the affected property of the taxpayer. <br />^ Revenue Agent 01/15/2010 (4D2)471-5928 <br />Slgtl Pr s ignatun: Title Date Telephone Number <br />here ^ Revenue Su ervisor 01/15/2010 <br />A orized Signet Title Date <br />4494.1974 Rev.2-2D02 Supersedes 4-494-1974 Rev, 1x7895 <br /> <br />v <br />