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L <br />Apr. 24. 2017 2:39PM NE Secretary at State — UCC <br />vcl <br />Nebraska Department of <br />REVENUE <br />Nebraska ID Number <br />36509892 <br />Lien Serial Number <br />11665752 <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 filed of record as Indicated, is continued, terminated, <br />partially released, or subordinated, to the extent indicated below, <br />Federal 113 Mintier <br />Lien Flied With <br />Secretary of State, Register of Deeds <br />Business Name and Location Address <br />Social Security Number <br />XXX -XX -5058 <br />Data of Llen <br />17- FEB -16 <br />Tax Years 2011: 2014 <br />UCC Instrument Number 16768 \ County Instrument Number 201601067 <br />® Termination of Tax The State Tax Lien is hereby Pally terminated. <br />Lien <br />Type of Action <br />I hereby certify that the Nebraska Depenment of Revenue has complied with the laws of the Stale of Nebraska in determination of the <br />confnuatlon, terminal rttal :::: se. rditiation Indicated above. <br />preparers Signature <br />diane.rickard <br />Erna <br />, Authorized ore <br />ka. ov <br />Ravenna Agent <br />Revenue Supervisor <br />Tide <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509 -4609 <br />Please Do Not Write In This Space <br />Tax Program <br />22 <br />County <br />(TALL <br />Taxpayer Name and Mailin Address <br />CRISPIN C CIPRIAN <br />811 W JOHN ST <br />GRAND ISLAND NE 68801 -6749 <br />201 2 2 <br />rot Sr. of ( ' ^ , Gale L 9 <br />11 11 <br />99 7790953 — i PSS: 1 <br />cIPRIRN CRISPIN C <br />Filed: 04/24/2017 10:24 PM <br />Date Phone Number <br />20- APR -17 <br />Date <br />Spouse's Social Security Number <br />20- APR -17 __lr_2. 1'� f 2 -1206 <br />4- 292 -19SB Rev. 1 -2015 <br />Supersadee 4-292 -1968 PIP a.2014 <br />