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Nebraska Identification Number <br />99542064 <br />Federal Identification Number <br />Social Security Number <br />XXX - XX - 2252 <br />Spouse's Social Security Number <br />XXX - XX - 0515 <br />Lien Serial Number <br />53430317 <br />Lien filed with <br />Date of Lien <br />12/09/2005 <br />Tax Category <br />22 <br />County <br />Hall <br />D Register of Deeds [J County Clerk <br />BUSINESS NA ME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Petty A Cummings <br />Street Address <br />Street or Mailing Address <br />609 N Sycamore St <br />City State Zip Code <br />City State Zip Code <br />Grand Island NE 68801 <br />Type of Action <br />ear <br />06/24/2013 MON 15:14 FAX 402 471 4429 UCC SECRETARY OF STATE <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) 2003 <br />❑ 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 />I hereby certify t - t the Ne <br />determination of th - inat <br />201305035 <br />r4 a � State Tax Lien Statement of Termination or <br />REVENUE Certificate of Partial Release or <br />www:ra,w,rtu+w.,;r'. *rte <br />Subordination <br />UCC Instrument Number <br />County Instrument Number <br />The State Tax Lien is partially released as follows: UCC Instrument Number <br />County Instrument Number <br />UCC Instrument Number <br />County Instrument Number <br />Pr <br />` Sig . <br />Revenue Agent <br />Title <br />Revenue Supervisor <br />Title <br />06/12/2013 <br />Date <br />Authorize ignature® <br />Hall 2002 /004 <br />vs See of stale John <br />A Gala -UCC <br />T09 <br />1111111111 <br />2013 f0 ;q® 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 />raska Department of Revenue has complied with the revenue laws of the State of Nebraska in <br />art',u,4 ase, or subordination indicated above. <br />C ead ^k 1 o- <br />07724 <br />308 632 - 1206 <br />Telephone Number <br />06/12/2013 <br />Date <br />4-232-68 Rev. &96 Supersedes 4-232-69 Rev. 10-95 <br />