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�� , , � <br /> � � � � <br /> � � � ..., <br /> � : � � � � � � �^ <br /> � � � <br /> , �� -� o � � <br /> � . : : ' � N c�, -*t c�a <br /> � .. � a � _�7 �' �...� S� <br /> �� �� ��\ y f+1 � <br /> w �r�� =--�, a �`,s�� � 2�. u� cs � <br /> �� �, r- :� <br /> � -- ,� � � r-- �;� c.� � <br /> ; ' "' �\ �,� �:n <br /> is � � � � --�a <br /> � _� � � <br /> � � � �v � �. <br /> z <br /> � State Tax Lien Statement of Termination "� <br /> �Iror Cert�ficate of Partial Release or <br /> nsbnska <br /> ���•�t Subordination � <br /> of rw�nw <br /> C"'� <br /> PLEASE DO NOT WRITE IN THIS SPACE � <br /> Parsuant to the revenue laws of the State of Nebraska,notice is hereby <br /> given that the State Tax Lien which has been duly filed by the Nebraska <br /> Department of Revenue against the below-named taxpayer,is terminated, <br /> partially released,or subordinated to the extent indicated below. <br /> Nebraska Identification Number Tax Category Social Security or Federal I.D.Number Sp4use's Social Security Number <br /> 73a9216 O1 21 —1 <br /> Lien Serial Number Lien Filed With Date of Lien County <br /> 8 �3 3 2 3 �]Register of Deeds �County Clerk <br /> BUSINESS NAME AND LOCATION ADORESS TAXPAYER NAME AND MAILING ADDRESS <br /> Business Name Name <br /> 1 , <br /> Street Address Street or Other Mailing Address <br /> a <br /> City State Zip Code Ciry State Zip Code <br /> TYPE OF ACTION <br /> �TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER 9 8-10 2 6 6 2 <br /> TAX YEARS (corporate, individual income, and withholding tax only) 19 9 7 <br /> ❑PARTIAL RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMBER <br /> TAX YEARS (corporate, individual income, and withholding tax oniy) <br /> ❑SUBORDINATION. The State Tax Lien is subordinated as follows. INSTRUMENT NUMBER <br /> Name of party making request and responsible for filing certificate of partial release or subordination with appropriate filing officer. <br /> I hereby certify that the Nebraska Department of Revenue ha complied with the revenue laws of the State of Nebraska in the determination of the <br /> termination,parti I release,or su rdination indicated above. <br /> sign � � Q C�ue� �� C ����/�� f3���;��.�=�c�� <br /> here reparer' nature � Tide Date TelephoneNo. <br /> �� a-ih��p � ���i�sl�� � <br /> Authoriz na re Ti�e ' e <br /> NEBRAS DEPARTMENT OF REVENUE-White and Canary Copies TAXPAYER-Pink Copy COUNTY OFFICE-Goldenrod Copy <br /> 4232-68 Rev.&96 Supersedes 4-232-68 Fev.10-95 <br />