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Jul. 14. 2015 2:45PM NE Se_retary of State - UCC <br />20151 <br />4 Ti ` <br />mob es � <br />Nebretarim.sneol <br />State Tax Lien Statement of Termination or <br />REVENUE Certificate of Partial Release or <br />w WIM,i s•Yn:o, raa.yr6M1! <br />Subordination <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 />Nebraska Identification Number <br />31518672 <br />Lien Sera Number <br />11548401 <br />® TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. UCC Instrument Numb 8957506146 <br />TAX YEARS 2012 County Instrument Number 201501617 <br />(corporate, Individual income, and withholding tax only) Continuance: UCC Instrument Number <br />Continuance: County Instrument Number <br />❑ PARTIAL RELEASE. The State Tax Lien is panlally released as follows: <br />TAX YEARS <br />(corporate, individual income, and withholding tax only) <br />SUBORDINATION. <br />sign <br />here <br />BUSINESS NAME MD LOCATION ADDRESS <br />1 h oerb the Nebraska <br />determination of the <br />Federal Identification Number <br />Lien Filed with Register of Deeds <br />The State Tax Lien is subordinated as follows. <br />ent of Revenue has complied with the revenue laws <br />ease,,or subordination indicated above. <br />Revenue Agent 07/06/2015 <br />Tide Date Telephone Number <br />07/06/2015 <br />Revenue Supervisor <br />Title <br />Social Security Number <br />XXJ(- XX-9434 <br />Type of Action <br />e oftlen <br />03/11/2015 <br />Tax Category County <br />22 HALL <br />AMI L WELLER <br />415 S CHERRY ST APT Al <br />GRAND ISLAND NE 68801 <br />UCC Instrument Number <br />County Instrument Number <br />UCC Instrument Number <br />County instrument Number <br />No 1781 P. 9 <br />NE 5.c of Si.ka John R G. a - UCC TO <br />111 11 <br />9915757757 -5 <br />WELLER HMI L <br />riled! 07/14/2 015 01 :58 PM <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 />Spouse's Social Security Number <br />TAXPAYER NAME AND MAILING ADDRESS <br />the State of Nebraska in <br />(308)632 -1206 <br />Date <br />4292 -6e Rev. 5.98 5opereedes 429249 Rev. 10.95 <br />Pas <br />