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<br />10/04/2007 THU 15:25 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1210021004 <br /> <br />oCfJ <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />200708584 <br /> <br />\111111\'111 <br /> <br /> <br />9907528490-5, P51$. 1 <br />;y~;~~ ~g~0~'2007 03: 16 P\'I <br /> <br />I1r <br /> <br /> <br />NOTICE OF STATE TAX LIEN <br /> <br />nobt3b <br />dop.ao1ll1tr1l <br />Of tt'ttllllt <br /> <br />PLEASE DO NOT WRITE IN THIS SPACE <br /> <br />This Notice of State Tax Lien -is issue~ by the Ne~raska Department of <br />Revenue for unpaid taxes pursuant to the revenue laWs of the state of <br />Nebraska. Notice is hereby given that taxes In~luding 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 acquired. <br />Nebraska Identification Number <br /> <br />37936948 <br /> <br />Lien Filed With <br />129 Register of Deeds D County Clerk <br />Lien Type <br />129 Ori~inal D Continuation <br /> <br />Social Security Number <br /> <br />Spouse's Social Security Number <br /> <br />505-134943 <br /> <br />Lien Serial Number <br /> <br />Date of Lien <br /> <br />County <br /> <br />071870159 <br /> <br />Dcorrected 10/01/2007 Hall <br /> <br />HHH mH--TAXPAYERNAMEANO- MAILING ADDRESS- "'" -" ""', ,-- "'I <br /> <br />1- - ""n__ m-BUSINES-S NAMEnAND-WCATIONn;.xDDRESS <br />Business Name <br /> <br />Street Address <br /> <br />Name <br />Roy G Towler <br />Street or Other Mailing Address <br />1218 N Broadwell Avenue <br /> <br />City <br /> <br />State <br /> <br />Zip Code <br /> <br />City <br /> <br />~2 <br /> <br />2005 04/24/2007 <br /> <br />297.00 <br /> <br />14.85 <br /> <br />29.86 <br /> <br />Slate Zip Code <br />NE 68803 <br />Additions Balance of I <br /> Assessment Due <br /> 341.71 <br /> <br />Grand Island <br /> <br />I Tax <br />Category <br />Number <br /> <br />Tax Period Date of <br />Assessment <br /> <br />Amount of Tax <br /> <br />Penalty <br /> <br />Interest <br /> <br />------ <br /> <br />._ u____.___n. __ .__.________.~__.. <br />.. ....... ......._ ............ ....... ......... ......... n. .............. _ <br /> <br />TOTAL <br /> <br />$ <br /> <br />341.71 <br /> <br />sign <br />here <br /> <br /> <br />Revenue Agent <br />Title Date <br /> <br />Revenue Agent Supervisor <br />Tille <br /> <br />Telepho Nu <br />/0 <br /> <br />Oat ~ <br />4"'94-1974 Rev. 2.2002 Supel$ede$4"'94-1974 Rev.l0-19S . <br /> <br /> <br />- \'.... <br />