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02/05/2013 TUE 14:52 FAX 402 471 4429 UCC SECRETARY OF STATE Hall 0002/005 <br />, c)ow <br />STATE TAX LIEN 0 NEBRASKA DEPARTMENT OF LABOR <br />■ TERMINATION <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />Employer or <br />Liable Person: <br />Address: <br />_ NDOL Acct. No.: <br />Federal ID No. / SSA No.: <br />This TERMINATION serves to remove the lien described below and the priority of the Nebraska Department of Labor on the <br />affected property of this employer or person. This Termination is filed pursuant to Neb. Rev. Stat. § §48 -657, 48- 660.01, 48 -664, <br />and the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. §77 -3901, et seq.). <br />X] FULL Termination l PARTIAL Release <br />Property description (ONLY if PARTIAL Release): <br />n/a <br />Date: February 5, 2013 By: <br />Tim D. Garrison f/d/b /a/ T W Construction <br />4339 West Stolley Park Road Grand Island NE 68801 <br />0257455002 <br />47- 0790606 <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />LIEN TO BE TERMINATED: <br />CATHERINE D. LANG <br />Commissioner of Labor <br />201300958 <br />NDOL Serial No.: LAB - 0129 -2003 <br />State Tax Lien Document N903275252 -7 <br />County: Hall �— <br />Logan <br />JO . ALBIN, Agency Legal Counsel <br />T :\ DOCUMENTS \FORMS\Liens \Termination.docx THOMAS A. UKINSKI, Legal Counsel <br />NE Sec of Stete John A <br />County Document Filing No.: 0803006012 <br />8703000138 <br />Go e - UCC TO <br />Pgs: <br />99137079652 <br />GARRISON T M D. <br />Filed: 02/05/2013 10 :49 AM <br />Other Filing Information: Org. filed Hall Co. 5/14/2003 @ <br />12:22 #200306012. Org. filed Logan Co. 5/13t2003 @ <br />3:30 Bk. 1 Pg. 38. <br />1 certify that the Nebraska Department of Labor has complied with the Employment Security Law of the State of <br />Nebraska in the determination of the amount due, and the employer or person has failed to pay the amount due after <br />demand. <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL NEBR. DEPT. OF LABO <br />CHARGE ACCT. #1476 <br />