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May. 5. 2017 '3:32PM <br />STATE TAX LIEN o NEBRASKA DEPARTMENT OF LABOR <br />• TERMINATION <br />Employer or <br />—_ _ - -- Liable Person: <br />Address: <br />NDOL Acct. No. <br />Federal ID No. / SSA No.: <br />This TERMINATION serves to remove the lien described below and the priority of the Nebraska Department of Labor on the <br />affected property of this employer or person. This Termination is filed pursuant to Neb. Rev. Stat. §§48 48- 660.01, 48 -664, <br />and the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev Stat. §77 - 3901, et seq.). <br />X <br />n/a <br />FULL Terrrlination l PARTIAL Release <br />Property description (ONLY if PARTIAL Release): <br />I certify that the Nebraska Department of Labor has complied with the Employment Security Law of the State of Nebraska <br />in the determination of the amount due, and the employer or person has failed to pay the amount due after demand. <br />Date: May 5, 2017 <br />T: 1DOCCJMENTS \FORMS\ Liens \Tennination.docx <br />Felipe Cruz f/b /d/a Renacimiento <br />309 N Walnut Grand Island NE 68801 <br />0293745004_ 47-0840034 <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />LIEN TO BE TERMINATED: <br />By: <br />JOHN H. ALBIN <br />Commissioner of Labor <br />NDOL Serial No.: LA33 -0136 -2006 - <br />State Tax Lien Document No. ,99.L6 ?c706, <br />County. Hall <br />County Document Filing No.: 0816000172 <br />Other Filing Information: Orig- Filed Co. January 12, <br />2016 ® 3:52 PM # 201600172 <br />NE Sec of 54.4e John <br />KATIE S. TIILJRBER, Agency General Counsel <br />THOMAS A. UKINSKI, Legal Counsel <br />DALE M. SHOTKOSKI, Legal Counsel <br />No. 3926 F. 2 <br />201170297 <br />dale - Lcc 1i <br />9917791534 -9 Pga <br />CRUZ FELIPE <br />Fled: 05/05/2017 02:56 PM <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />Ncsi) <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL NEBR. DEPT. OF LABOR <br />CHARGE ACCT. #14765 <br />