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Nebraska Department of <br />REVENUE <br />Nebraska 10 Numbet <br />8923027 <br />lien Serial Number <br />11428225 . <br />Nov. 16. 21:116 3:23PM • NE `secretary of State — UCC • <br />State Tax Lien -- Statement. of Continuation or <br />Termination; Certificate of Partial Release <br />or Subordination <br />Pursuant to the revenue laws of the State of Nebraska, the <br />Tax Commissioner hereby gives notice that the State Tax Lien' <br />against the'taxpayer identified below, the original notice of which <br />was duly tiled of record as indicated, is continued, terminated, <br />partially released, or subordinated, to the extent indicated below. <br />Tax Years 2010, 2011 & 2012 <br />UCC Instrument Number <br />Federal ID Number • <br />Lien Filed With .. <br />Secretary of State, Register of Deeds <br />Business Name and Location Address <br />[8] Termination of Tax The State Tax Lien is hereby fully terminated. <br />Lien <br />Please Do Not Write In This Space <br />Social Searirlty Numbet <br />XXX- XX -S675 <br />Date of Lien <br />01/23/2014 <br />Tax Program <br />01 <br />9916782783 -3 Pstl • <br />DAVIDSON KATHLEEN G. <br />Filed: 1111612016 10;44 RR <br />county <br />11ALL <br />Taxpayer Name and Mailing Address <br />KATHLEEN C. DAVIDSON . . <br />226 W. STOLLEY PARK RD <br />GRAND ISLAND NE 68801 <br />County Instrument Number 201400543 <br />24 .69,!7702 <br />E Sec PC' a aye .1141.11 A d.1. -AMC T09 <br />Spousc+s Social Security Number <br />Type of Action <br />.1 <br />I hereby certify that the Nebraska Department of Revenue has complied with the laws of the State of Nebraska in determination of the <br />t nation, partt:.r1tT . e,'or Subordination indicated above <br />i <br />s <br />=parer'S Signature <br />• <br />ronedd,desninsgncbraska.eov <br />EmailtAddress I <br />na / f enue Senior Agent <br />natut f �� Title av <br />'Au tho hz`d s i <br />I� �t (' — <br />Date <br />Revenue Agent 11/10/2016 (402)471 -6067 <br />Title. Date Phone Number <br />4- 02a96e Rev. 1-2016 <br />supersedes 4. 292 -1968 Rev. 6-2014 <br />