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01/18/2007 15:31 FAX 14024714429 NEBRASKA Dee IaI 0021002 Please return to: STATE OF NEBRASKA DEPARTMENT OF REVENUE 1811 WEST 2NO ST STE 460 GRAND ISLAND NE 68803 2007004,60 . \("'111111 9917490794-4 Pss: 1 . MTL.E'l' ALVIN G Filed, m1/18/2007 12;37 PM & Ilr NOTICE OF STATE tAX LIEN noIlrU~ dtptlrtmot'll of rt\'trlu. PLEASE DO NOT WRITE IN THIS SPACE This Notice of State Tax lien is issulild by the Nebraska Department of Revenue for unpaid taxes pursuant to the revenue laws of the s~te of Nebraska. Notice is hereby given that taxes including penalties and interest. which are shC?wn below, are due from the taxpayer specified below and remain unpaid after demand. These taxes constitute a lien in the county for real and personal property beionging to the taxpayer or hereafter acquired. . Nebraska Identification Number' .' . .. . . ..... . . '. .' Federal Identification Number . '~.5~29609"'. ,":'" ..".;": ., .':.~:,;'::::;v .:i;':,:;:.\ ::':';:':.'>: '. c,',.,;::.;::'. ';:' .:'.':';~... '.,;;:::<' .:.' ;..': ::'.,;, '. '. -.:,; ....... . '. ;':-':"1';' ,..':'; Lien Serial N~mber Li~n Filed With ; Socia\ Security Num~e~ " Spous~',~ Social s:ec.u.riIY,Nu'inber" ''(/3 /n'.j 1 ;;Qo.'~ '; .. . [!] R!!lgisfefbf Deeds'-' 0 bounty' Clerk ; ~05 54 2992:.. . u'" .-. ..' .. -.. ...... Dale 6f Lien ., Lien Type .County 12/25/2006 0 Original. O'c~ntin~alion 0 c~rre~ted . . Hali . . .' r BUSINES'S NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS 1 Business Name Name Alvin G Motley .StrElet or Other Mailing Address 2431 N Custer Street Address ~ City State Zip Code I Tax Category . Tax Penod Date of . Amount of Tax Number Assessment 01 04/01/2004- 11/26/2006 3.696.92 09/30/2006 City State Zip Code Grand Island NE 68~03 Penalty Interest Additions Balance of 1 Assessment Due 1,494.41 327.12 5,518.45 . "W _ ~ .'" ' . _ _, _,.~_ _'~'r or" ,'_'.'_ _. ._., ~._.~.._ _~ ...... .~.... .u..... n ,. .~- I ". . I ~ . 'j ,i', ,.', - \ ..' . '.' '" sign here I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the amount shown to be due, and the taxpayer has failed to pay the amount due after ~ema.nd. If this Notice of State Tax Uen is an extension of an e ectlve lien, it serves to continue lhe'priority of the stale'.s interest in the affected property of the taxpayer. . .. .. .. . .., Reven~~ Senior A~~nt" . . JII*,/~O~? -' 308 385-6073 ... p S' T'ltle. Date Telephone Number repare signature I )\ . ~ * Revenue Supervisor . //1 ~/otc. ... ~"O:iz'~fe' . Tille . Dale ~'\ SC(::iJ(Jntu 4"<1ll4.1974 Rev. 2.2002 S'upers.doa4.-494-1974 P..', lo..19fi~ .i t.:.'i ; . ~ ,_\-"".. ~r' TO!AL .'u' $ :.. ~ .5,518.45_ ..