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Nebraska IdenUllcat on Number <br />10586679 <br />Federal Identification Number <br />80- 0439865 <br />Social Security Number <br />XXX - XX - 9740 <br />Spoues's Social Security Number <br />Lien Serial Number <br />11366347 <br />Lon filed with <br />Date of Lien <br />07/19/2013 <br />Tax Category <br />01 <br />County <br />Hall <br />Q Register of Deeds County Clerk <br />I BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME ANO MAILING ADDRESS <br />Buaineae Name <br />Name <br />GARY LEMBURG <br />Street Address <br />Street or Mehra Address <br />2805 FT WORTH AVE. <br />City State Zip Code <br />City State zip • • = <br />GRAND ISLAND NE 68803 <br />Deo,17. 2014 2:49PM NE Secretary of State - UCC No, 8247 P. 2/6 <br />201407933 <br />TAX YEARS (corporate, Individual income, and withholding tax only) <br />sign <br />here <br />State Tax Lien Statement of Termination or <br />REVENUE Certificate of Partial Release or <br />Subordination <br />Pursuant to the revenue laws of the State of Nebraska, notion le 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 />Type of Action <br />© TERMINATION OF TAX LIEN. The Stale Tax Uen is hereby fully terminated. UCC lest Number _e 71.9577-3 <br />County Inet Number 201305996 <br />TAX YEARS (corporate, individual income, and withholding tax only) 2013 <br />❑ PARTIAL RELEASE. The State Tax Uen le partlaly released as Wows; UCC Instrument Number <br />County Instrument Number <br />SUBORDINATION. The State Tax Lien is subordinated as foibles. UCC Instrument Number <br />County Instrument Number <br />fpnature" 1 Title <br />PM Sac et Sinks John a ants - UeG Tea <br />8914746218 -0 P $e; 1 <br />LEMURS QARY <br />Filed, 12/17/2014 11:14 riff <br />PLEASE DO NOT WRITE IN THIS SPACE <br />partment of Revenue as comp with e revenue aws of the tats ` = ras a in <br />al release, or subordination indicated above. <br />Revenue Agent J.I% /c<f! 402 471 - 6067 <br />'Title Date Telephone Number <br />Revenue Supervisor <br />Date <br />4-292$ Rev. Me S'4 Rev. i <br />• <br />