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06/13/2001. 15:41 FAX 14024714429 NEBRASKA UCC Z005/007 <br />Ne 'Scc of �1�!• -UGC <br />� � I IIIIIl11111 11/11 11111 11111 I�lil Ifllllll <br />9901148787 F9s t <br />ARVIN RRCHIE L <br />Fl led 11:12 AM <br />200105705 <br />Notice of State Tax Lien <br />Or <br />nelueslka <br />depertnlent <br />of revrlue <br />PLEASE DO NOT WRITE IN THIS SPACE <br />3 R141MATION 0 STATE TAX LIEN <br />L INCOME TAX <br />IF YOU INQUIRE ABOUT YOUR <br />ACCOUNTt REFER TO THESE NUMBERS: <br />SOC. SEC. NO <br />NEBR- IDENT- NO. <br />SPOUSE SOC- SECS NA. <br />TAXABLE YEAR <br />LIEN.NOe <br />LIEN RELEASE NOe <br />COUNTY <br />DATE OF NOTICE <br />505703763 <br />16955269 <br />508705167 <br />1996 <br />971840080 <br />41.1566729 <br />5Ob/0%2,001 <br />ARCHIE L S MARY K ARVIN <br />1930.ROSMELL RD APT 30'7 <br />MARIETTA GA 30068 <br />INSTRUMENT NOe 4� , I bm;l.'. 0591 -10 4 ;3 <br />PURSUANT TO THE REVENUE. LAMS OF. THE STATE OF. N£8RASKAj . Nf3TICE IS <br />HEREBY GIVEN_BY.THE.NEBRASKA DEPARTMENT, ©F REVENUE THAT THE <br />STATE TAX LIEN WHICH-HAS BEEN DULY FILED AGAINST THE ABOVE'NAMED <br />TAXPAYER FOR INDIVIDUAL INCOME TAXES -IS TERMINATED- <br />I HEREBY CERTIFY.THAT -THE NEBRASKA DEPARTMENT OF REVENUE HAS COMPLIED <br />WITH THE REVENUE LAWS - ©f THE STATE OF NEBRASKA IN THE DETERMINATION OF <br />THIS TERMINATION- <br />..A ou" <br />'REP <br />HOR ED SIGNATURE T <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff NE 69363 -1500 <br />- <br />TLE <br />ENT OF REVENUE — White and Canary Copies <br />4116 LJOUIL0 a a so <br />DATE <br />DATE <br />TAXPAYER — Pink Copy <br />7.145.1979 Rev, 2 -2000 Supersedes 7 -145.1 979 Rev_ 101995 <br />