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�', , <br /> o . ✓ <br /> \ � �-� <br /> y . �� � � � rn <br /> � °n � �' � ", �O v <br /> ( 'c � -,a <br /> "�7 7 `\ N c� '�*� ' �. <br /> y ��' O -n �, <br /> r� �'—+ cy <br /> ` ,T,.,. f�'1 N <br /> � \,f°J k tv O <br /> � � � � r� � � "3 N <br /> �� ; "�u � � � .� <br /> � �\`'1`` �' �� � -v c <br /> `> � <br /> �\ �� ...�. � cD <br /> � �`p� C.� � �9 .-�i- <br /> � (�` Z <br /> v� O <br /> , <br /> � � State Tax Lien Statement of Termination <br /> �Ir�� or Certificate of Partial Release or � <br /> � Mb1iiW <br /> � ' ��^� Subordination <br /> «..r«,w <br /> PLEASE DO NOT WRITE IN THIS SPACE <br /> !'ursuant 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 indlcated below. <br /> `r <br /> Nebraska Identification Number Tax Category Social Security or Federal I.D.Number Spouse's Social Security Number <br /> 6033792 _ <br /> Lien Seriat Number Lien Filed With Date of Lien County <br /> 7/10/3 4 3 [�Register ot Deeds ❑County clerk <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 Zp Code City State Zip Code <br /> TYPE OF ACTION <br /> [�TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER 97-108455 <br /> TAX YEARS (corporate, individual income, and withholding tax only) 19 9 4, 19 9 5, 19 9 6 <br /> []PARTIAL RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMBER <br /> TAX YEARS (co�porate, individual income, and withholding tax only) <br /> ❑SUBORDINATION. The State Tax Lien is subordinated as follows. INSTRUMENT NUMBER <br /> Name of paRy makirg request and responsible for filing certificate of partial release or subordination with appropriate filing officer. <br /> I hereby certif�r that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br /> termination,partial release,or s bordination indicated above. <br /> . .. <br /> h�9n � r� �a�3�s�-�►l� <br /> e re ��s Signature T e Date/ Telephone No. <br /> � r �- / T <br /> . <br /> Authoriz i na e TMe , e <br /> NEBRAS DEPAR E F REVENUE- hite and Canary Copies TAXPAY -Pink Copy COUNTY OFFICE-Goldenrod Copy <br /> a2a2-se Rev.aes supersedes a2s2-se aev.�ass <br />