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04/26/2012 THU 14:47 FAX 402 471 4429 UCC SECRETARY OF STATE �-�� Hall <br />� �` <br />�U1�U`��4� <br />� , ,,,r.. ,,,.��„ . ' <br />r..�..�...r...� <br />�s.�es <br />99l2692 <br />�looz/oo3 <br />B Gele � UCC T08 <br />P9s: 1 <br />09:48 AM <br />,��� �,� . State Tax Lien Statement of Termination� or , <br />���� Certificate of Partial Release or <br />.+.n�„w..�,�.►r..►Y�.n..+irov <br />Subordination � <br />Pursuant to the revenue laws of the State of Nebraska, notice is hereby PLEASE RETURN T0: <br />given that the State Tax Lien whlch has been duly flled by the Nebreska NEBR/kSKA DEPT OF REVENUE <br />Departm�nt of RO�enue against the below-nam�d taxpayer, is � 1313 FARNAM-ON THE-�IIALL <br />terminated, partially released, or subordinated to the extent indicated OMAMA NE 68102-1871 <br />below. <br />Nabraska Identiflcatlon Number Federal Identification Number Soc3al Security Number Spouse's Social Securit <br />44504543 . XXX XX . <br />Lien Sarial Number Lien filed with Date of Lien Tax Category County <br />90090288 QX Register of Deads �County Clerk 01/09/2009 22 Hall <br />' BUSINESS WAME AND LOCATION ADDRESS � TAXPAYER NAME AND MAILING ACD1tESS: <br />Sylvia L Carruth <br />treet or Mailing Address <br />246 North Darc . . <br />� Grand Island NE <br />Type of Acdon <br />QX TERMINATION OF TAX LIEN. The State Tax L[en is hereby fully terminated. UCC Instrument Number <br />.. �,. � , �; <br />Tp Code <br />68803 � � <br />` ���c <br />Couniy IrtistTUmeM Number 200904877 <br />TAX YEARS (corporate, indivfdual income� and wlthholding tax only) 2005 <br />� PAR77AL RELEASE. The State Tax Lien 1s partiaUy released as follows: UCC Instrument Number <br />� County I�strument Number <br />TAX YEARS (eorporate, indiv(dpal income� and vvtthholding te o nly) <br />� SUBORDINATION. The State Tax Lien is subordinated as follows. UCC Instrument Number <br />Courrty Insbvment Number <br />determination <br />sign <br />here <br />release, or suboMinatfon indicated above. <br />Revenue Agent 04/23/2012 308 632-1206 <br />Tide Date Telephone Number <br />Revenue Supervisor � 04/23/1012 <br />Title Date <br />4-232�8 Rev. &96 Supersedes 4232�9 Rev.1Q-95 <br />� <br />� <br />