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Nebraska Identification Number <br />40750434 <br />Federal Identification Number <br />Social Security Number <br />•• <br />Spouse's Social Security Number <br />Lien Serial Number <br />72080164 <br />Lien filed with <br />Date of Lien <br />01/06/2009 <br />Tax Category <br />22 <br />County <br />HALL <br />X Register of Deeds DCounty Clerk <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />JESUS J FLORES <br />Street Address <br />Street or Mailing Address <br />10036 HOLLAND CT <br />City State Zip Code <br />City State Zip Code <br />BROOMFIELD CO 80021 <br />I Type of Action J <br />01/22/2013 TUE 15:25 FAX 402 471 4429 UCC SECRETARY OF STATE Hall 0002 /004 <br />State Tax Lien Statement of Termination or <br />ammaimmainmat REVENUE Certificate of Partial Release or <br />wwwr..�vrsusr:, na.ijpsv <br />Subordination <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 <br />terminated, partially released, or subordinated to the extent indicated <br />below, <br />TERMINATION OF TAX LIEN. The State Tax Lien Is hereby fully terminated. <br />TAX YEARS (corporate, individual income, and withholding tax only) 2004 <br />0 PARTIAL RELEASE. <br />TAX YEARS (corporate, individual income, and withholding tax only) <br />0 SUBORDINATION. The State Tax Lien is subordinated as follows. <br />sign <br />here <br />det <br />I h b . at braska Department of Revenue has complied with the revenue laws of the State of Nebraska in <br />e ter nation, partial release, or subordination indicated above. <br />Revenue Agent <br />Title <br />u 0 ` ' Signature <br />The State Tax Lien is partially released as follows: UCC Instrument Number <br />County Instrument Number <br />Revenue Supervisor <br />Title <br />201300545 <br />UCC Instrument Number <br />County Instrument Number <br />UCC Instrument Number <br />County Instrument Number <br />01/16/2013 <br />Date <br />NE See of State John A Gale - UCC T09 <br />9913706963 -7 P9 s: 1 <br />FLORES JESUS J <br />Filed: 01/22/2013 08:56 AM <br />PLEASE DO NOT WRITE IN THIS SPACE <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />990 9581980 <br />200900109 <br />308 632 -1210 <br />Telephone Number <br />01/16/2013 <br />Date <br />4- 23268 Rev. 8-96 Supersedes 4 -232-69 Rev. 10-95 <br />