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May. 10. 2016 3: i9PM NE - _ : re.ta. ry of State - UCC Nc,. 6426 P. 12 <br /> • <br /> 201602888 <br /> 0 N0 Sate of stair Jell A 6.1e - etC T09 <br /> PLEASE RETURN TO: <br /> NEBRASKA DEPT OF REVENUE 9916770496-3 Pig g 1 <br /> PO BOX 94609 NICHOLS CHARLES H JR <br /> riled: 06/10/2016 11:10 An <br /> LINCOLN NE 68509-4609 <br /> worse "4-----r— of State Tax Lien Statement of Termination or <br /> REVENUE Certificate of Partial Release or <br /> Subordination <br /> PLEASE DO NOT WRITE IN THIS SPACE <br /> • <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 Federal Identification Number Soda'Security Number Spouse's Social Security Number <br /> 96801743 XXX-XX-6494 <br /> Lien Serial Number Date of Lien Tax Category County • <br /> 11552827 Lien filed with Register of Deeds 06/09/2015 22 HALL <br /> BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> CHARLES H NICHOLS JR <br /> 106 WETZEL ST <br /> GRAND ISLAND NE 68801 <br /> • <br /> • <br /> Type of Action <br /> TERMINATION OF TAX LIEN. The State Tax Den 1s hereby fully terminated. UCC Instrument Numb(rq 57.S UZI 34- <br /> TAX YEARS 2009,2010,2011 County Instrument Numbei 201504072 <br /> (corporate,Individual Income,and withholding tax only) Continuance:UCC instrument Number <br /> Continuance;County Instrument Number <br /> Q PARTIAL RELEASE. The State Tax Lei la parrally released as follows; UGC instrument Number <br /> TAX YEARS County Instrument Number <br /> (corporate,individual income,and withholding tax only) <br /> SUBORDINATION. The State Tax Lien is suborcinated as follows. UCC Instrument Number <br /> County Instrument Number <br /> • 1 yy .. +' the profits Department of Revenue has complied with the revenue laws of the State of Nebraska in <br /> d ! I:4176 -term I release,or 6ubordinadon indicated aeve, <br /> sign Revenue Agent <br /> 04/20/2016 (308)632-1210 632-1210 <br /> here _ r: <br /> Title 'Date Telephone Number <br /> A � Revenue Supervisor 04/20/2016 <br /> A''ri -• 'ure 9 Title Date <br /> 428299 Rm cao Supotuu10e 4M2-tt RW.1045 <br /> • <br />