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Dec. 24. 2014 2:26PM NE Secretary at State — UCC No. 8379 <br />rifa <br />STATE TAX LIEN o NEBRASKA, DIEPA.RTIONT OF LABOR <br />1 • T>eRJ11a[+►ATI014 <br />Employer or <br />Liable Person: <br />Address: <br />NDOL Acct. No.; <br />Federal ID No. / SSA No.: <br />Donn K Hickok <br />507 Nubia St. Cairo 14E 68824 <br />0328859008 <br />loot-n-9614 <br />3t — FULL Termination I PARTIAL Release <br />1'roprity description (ONLY if PARTIAL Release): <br />Date: December 24, 2014 By: <br />T:kDOCUMENTSTORMMLiaiffennInagonAlotot <br />201408112 <br />LIEN TO BE TE i STED: <br />County: <br />JOHN H. ALBIN <br />Acting Commissioner of Gabor <br />Hall <br />THOMAS A. UKINSr1Q, Legal Counsel <br />KATIE S. TIMBER, Legal Counsel <br />he aeC Of Si.*. John A Sole - U[C TM <br />11111111 I 11 <br />iV (I <br />9914746583-i Pew ; 1 <br />HICKOK DOAN1 K <br />Flied 12121/2814 09:17 WI <br />NDOL Serial No.: LAB- 0220-2014 <br />County Doc unent Filing No.: 0814007821 <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471-9912 <br />FAX - (402) 411 -9917 <br />This TERMINATION serves `Lo mare tip 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. Stag § §48 -657, 48- 660.01, 48 -664, <br />and the Uuiform State Tax Lint I O s:rat an a Enforcement Act (Nob, Rev. Stark §77-3901, et aeq.). <br />State Tax Lien Document No.: 9914745979 -9 <br />Other Piling 1nfonnation: Orig. Filed Co 12/12/2014 <br />3:18 # 201407828 <br />I certify that the Nebraska Department of Labor has complied with the Employment Secarity Law of the State of Nebraska <br />in the determination of the amount due, and the employer or person has failed to pay the amount due after demand. <br />RETURN FILED COPIES TO Nebr. Dept. of Labor - LEGAL NEBIL DEPT. OF LABOR <br />P.O. ltos 94600 CHARGE ACCT. #14765 <br />Ltlaeda. NE 685094600 <br />