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09.'09/2000 10:22 FAX 14024714429 <br />t-\ ) <br />Or <br />nebrfrret <br />AepentmerK <br />or meal» <br />NEBRASKA UCC <br />200006453 <br />Z 002/002 <br />1811111 X1111 Il�1l 11~1111111 i1ii11��� Ili <br />90 0074545 P95 <br />FITZG'eRPA-O PATRICK L <br />Filed 0810912000 09 20 AID <br />State Tax Lien Statement of Terminatj, <br />or Certificate of Partial a eas r <br />Subordination <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 -tamed taxpayer, Is terminated, <br />partially released, or subordinated to the extent indicated below. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska Identification Number Tax Category Social Security or Federal I.O. Number Spouse's Social Security Number <br />12604879 22 506 -42 -8182 505-68-45-83 <br />Len Serial Number Lien Fled WIM Data of Iron Couray <br />982610077 jaRegistar of Deeds [I County Clerk 07-11-2000 <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />,.._ -_ --- Name <br />Streator Other Mailing Address <br />Zip Code I City State ZIP Code <br />TYPE OF ACTION <br />TERMINATION OF TAX UEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER / <br />TAX YEARS (corporate, Individual Income, and withholding tax only 996 & 1998 UDC 9900069495 7 -17 - <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 />❑SUBORDINATION. The State Tax lien is subordinated as follows. INSTRUMENT NUMBER <br />Retum to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />Name of party making request and reap Onsiblefor filing certificate of partial release of subordinall -with appropriatefifing officer, <br />I hereby certify that the Nebraska Department of Revenue has oomplied with the revenue laws ottTie State of Nebraska b the determination of the <br />ter I Ion, partial lease , ywbordinatior indicated above. sign � ljE"w lq-5-x_ T`�"�yl�olt <br />here eparer•3Signature Tm Date <br />Z Title Date– <br />NEBRASKA DEPARTME OF REVENU - <br />White and Canary Copies TAXP ER - Pink Copy COUNTY OFFICE - Goldenrod Copy <br />4232.69 Rev. 6.96 8upers 4.232-69 0- <br />