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04/01/2013 MON 14:30 FAX 402 471 4429 UCC SECRETARY OF STATE <br />— ._...... Employer or ....................._...................... ........_....................._ <br />Liable Person: Gail D. Klingsporn <br />Address: 603 Lilly St. wood River NE 68883 -2141 <br />NDOL Acct. No.: 0319367007 <br />Federal ID No. / SSA No.: xxx -xx -2646 <br />n/a <br />Date: April 1, 2013 B <br />T :\ DOCUMENTS \FORMS\Liens \Termination.docx <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />201302608 <br />STATE TAX LIEN ❑ 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 />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 />LIEN TO BE TERMINATE <br />X I FULL Termination l I PARTIAL Release <br />Property description (ONLY if PARTIAL Release): <br />CATHERINE D. LANG <br />Commissioner of Labor <br />Hall <br />NE Sec of S!a }g <br />John A Gale <br />- UCC TOG <br />1111 <br />Filed: 04/01/201 10:45 AM <br />NDOL Serial l .. LAB- 0082 -2013 <br />State Tax Lien Document No.: 99137106_, <br />County: Hall <br />County Document Filing No.: 0813001995 <br />Other Filing Information: Org.;filed Co. 3/14/2013 <br />3:05 #201301995. <br />U002/004 <br />I certify that the Nebraska Department of Labor has complied with the LMployment Security Law of the State of <br />Nebraska in the determination of the amount due, and the employer or period has failed to pay the amount due after <br />demand. <br />NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />