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05/26;2000 12:54 FAX 14024714429 NEBRASKA UCC <br />0 <br />1x002/002 <br />1 illili Illlf IIIII 11111 IIIII Illll 1111 illl'� <br />9900037801 P9a: f <br />KELLY RICHARD SCOTT <br />Filed 0512512000 10 38 AM <br />State Tax Lien Statement of Termination <br />Or or Certificate of Partial Release or <br />I "t Subordination <br />cal rerNnM <br />PLEASE DO NOT WRITE IN THIS SPACE <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 terminated, <br />partially released, or subordinated to the extent Indicated below. <br />Nobratka IdentificationNtmber Tax Category Social Security or Federal I.D. Number Spouse's Social security i <br />7936753 withholding 21 506 - 90-7257 <br />Lien Serial Number Lien filed with Osto of Lion CourltY <br />9 -08 -201 RegrsterofDead$ ❑CountYClerk 6-27-99 Hal I <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Namo <br />Other <br />Zp Code City Slate 21p Code <br />TYPE OF ACTION <br />ETERMINATIO F TAX LIEN. The State Tax lion is hereby fully terminated. INSTRUMENT NUMBER 99108 <br />9 y� 1998 UC 40621 <br />TAX YEARS orporate, Individual Income, and whhholdin tax onl <br />P RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMBER <br />TAX YEARS (corporals, Individual Income, and withholding tax only) <br />SUBORDINATION. The State Tax Lien is subordinated as follows. INSTRUMENT NUMBER <br />Name of party making request and respc0blefor filing certificate of partial release or subordination wAih appropriate filing officer. <br />I hereby oar* that the Nebraska Depaftent Of Revenue has COrnpf led with the revenue laws of the State of Nebraska In the dotermination or me <br />lion, partial release, cr au n indicatq! above. <br />sign 2 gey 13nL AQPnt <br />here Signature TICe - Data TeiephoneNo. <br />.cz <br />$cvac or Aar3nt S <br />Authorized signature Title Dale <br />NEBRASKA DEPARTMENT OF REVENUE - Whale and Canary Copies TAXPAYER - Pink Copy <br />COUNTY OFFICE 04 rAW"d" Goldenrod Rev 10-9 <br />