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�C � <br /> � � <br /> � � � ` � <br /> '� �� C7 "� <br /> :� � �y � F7 •--{ �._�,.. <br /> c, (r �� � � �" �,� �� <br /> � , 7 � �-r,� � r � 'J <br /> � Y' �, � � �' � <br /> �'`, t..J ca �*'+ ' _n <br /> \ ;�1 > ���' � -ri �, 1--+ _--; <br /> 'y r�7 <br /> �� � <br /> '`. � �:,�� <br /> � M�"v ..� t c,:i O '_; <br />,� � �.a. � r :, �._ <br /> � \ r� Y h\l � ' � O '� <br /> � � <'� <br /> , y 3 <br /> tJ 1 �, ..�. <br /> t � v� 7 <br /> � �n � .s � <br /> � � State Tax Lien Statement of Termination <br /> �� �r <br /> or Certificate of Partial Release or <br /> nebraska <br /> �.Pa�.M Subordination <br /> of►avenu� /J�� <br /> PLEASE DO NOT WRITE IN THIS SPACE �� <br /> Pursuant 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 Spouse's Social Security Number <br /> 28913 35 <br /> Lien Serial Number Lien Filed With Date of Lien County <br /> 912 5 6 012 0 �Register of Deeds �County Clerk 9_1 _ <br /> BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> Business Name Name <br /> , <br /> Street Address Street or Other Mailing Address <br /> City State Zip Code City State Zip Code <br /> TYPE OF ACTION <br /> [�TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER 91-l0 II 3 0 6 <br /> X 1987 <br /> TAX YEARS (corporate, individual income, and withholding tax only) <br /> ❑PARTIAL RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMBER <br /> TAX YEARS (corporate, individual income, and withholding tax only) <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 certity that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br /> terminati n,partial release,or subordination indicated above. <br /> si9n � ��,,�, Q.�- �-�o-9g c��>385-lQ07� <br /> here Prepa er'sSignature Title Date TelephoneNo. <br /> �r,..+�..,,,,p ��/°��� �-��,�✓�/��._i �`3 9 <br /> Qj� thoriz i r Trtle V ��/ ate <br /> NEBRASKA DEPARTME OF REVENUE-White and Canary Copies TAXPAYER-Pink Copy COUNN OFFICE-Goldenrod Copy <br /> 4232-68 Rev.&96 Supersedes 4-232-68 Rev.10-95 <br />