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05/17/2001 13:05 FAX 14024714429 NEBRASKA UCC Q002/003 <br />oq <br />NE Ste •f Sr.ia - UCC 07 <br />I Illlll lilll IINI Illll illli 11111 1111 IIII <br />990114Z224 P95 : <br />KOPYS FINE SHOES <br />Filed 0511112001 11:00 AM <br />2001 046 <br />45� <br />State Tax Lien Statement of Termination <br />Ir or Certificate of Partial Release or <br />"" ur ent <br />deperOn Subordination <br />m r"wr.i <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 />Nebraska Identification Number <br />Tax Category <br />Social Security or Federal 1. D. Number <br />Spouse's social Security Number <br />3973859 <br />01 <br />505 -56 -5878 <br />Lien Serial Number <br />Lien Filed With <br />Date of Lien <br />County <br />4/01/465 <br />® Register of DBMS C] County clerk <br />01-23-84 <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />BualnessName <br />Name Robert L Kopystynski d /b /a <br />Kopys Fine Shoes <br />Kopys Fine Stiogs <br />Street Address <br />Street or Other Maiirrg Address <br />Conestoga Mall <br />3228 W 18th Street <br />City State Zip Code <br />City State Zip Code <br />Grand-llsJ,,and NE 68801 <br />lGrand Island NE 6BL901 <br />TYPE OF ACTION <br />E F TAX LIEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER 12 -12 -88 <br />TR corporate, individual Income, and withholding tax only) <br />PARTIAL RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMBER <br />TAX YEARS (corporate, Individual Income, and withholding tax only) <br />❑ SUBORI NATION. The State Tax Lien is subordinated as follows.. INSTRUMENT NUMBER <br />please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2N1 ST STE 460 <br />GRAND ISLAND NE 68803 <br />Name of party making raquost and responsible iorfling certificate of Wall release or subordination with appropriate filing officer. <br />sign <br />here, <br />termination, partial release, or <br />OF <br />Department of Revenue has compiled with the revenue laws <br />;loon Indicated above. <br />the <br />rraae- t+s'- �ti c3o�i38S�64i <br />!� Title Date Telephone No <br />Title Da <br />- White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy <br />+232.68 Rev. 0-96 SupxNdws 4222.68 Rev- 10-9a X <br />