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07/29/2010 THU 15:41 FAX 402 471 4429 UCC SECRETARY OF ST'AT8 yyy Hall <br /> <br />Please return Capy to: <br />Nebraska Dept of Revenue <br />PO Box 94818 <br />Lincoln NE 68509 <br />2oioo529s <br />~~~~ <br />Nebraska Department of <br />REVENUE <br />www.r~v[~rru(3.rio.gav <br />X002/002 <br />NE See of Stata Jnhn A bate - IICC STL <br />8910633355-4 Pgs: 1 <br />ALI ABpIRIZAAK <br />Filed: ©7/29/2010 09:20 AM <br />NOTICE OF STATE TAX LIEN <br /> PLEASE DO NOT WRITE IN THIS 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. 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 uired. <br />Nebraska IdenlificaGon Number Federal Identification Number <br />979704D9 <br />Lien Serial Number Lien Filed Wilh Social Security Number Spouse's Social ecurily Number <br />11042203 ®Register of Deeds County Clerk XXX-XX-5510 <br />Date of Lien Lien Type County <br />07/27/2010 ®Original Continuation Corrected HALL <br />BU5INE:S5 NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> ABpIRIZAAK ALI <br /> 510 CEDAR AVE SOUTH APT 1 <br /> MINNEAPOLIS MN 55454 <br />Tax <br />Category <br />Number Tax Period pate of <br />Assessment Amount of Taz Penalty Interest Additlons Balance aF <br />Assessment Due <br />22 2007 06/28/2009 360.00 27.40 70.82 858.22 <br /> <br /> <br /> <br /> <br /> TOTAL $ a58.22 <br />I hereby cerU y that the Nebras ka apartment of Revenue has complied wi th the revr?nue taws nr the sra1P nr Nwhracka ~., rnp rin lormin~Knn nr the <br />amount shown to be due, and the taxpayer has failed to pay the amount due after demand. If this Notice of Slate Tax Lien is an extension of an <br />effective lien, it serves to ontinue the prix ' of the state's interest in the affected property of the taxpayer. <br />^ Revenue Agent (402)471-5928 <br />S1~11 Prepare Si a Title Dat Telephone Number <br />here ^ Revenue Su ervisar Z <br />Authorized Signature Title Date <br />4.494-1974 RQv, Z-7W2 Supersedes Id94-1971 ReV.10-1995 <br /> <br />t <br />