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F <br />State Tax Lien <br />Statement of Termination or <br />F r� t Certificate of Partial Release or Subordination <br />{ Lien Serial Number Document Serlat Date of Lion Social Security Number or <br />r Number Federal 1 . Num er <br />8/04/787 11982 4 -20 -88 505 -4 6701 <br />Q01'�g <br />braska 1.0. Number County Lien Filed With spouse's Social Security <br />RagistPr of Beds Number <br />4,5 I1 ❑ County Clerk <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Nama Name <br />Street Address Street Zr Other Mailing Address <br />3904 Pony Express Road <br />City State ZIP Code City State zlo,civlo <br />Kearney NE* 68M, <br />Ptu><wnt to the revenue lows of the State of Nebcasks, notiw Ps hrreby giiwn that the State Tux Lich W- ti h •brae been dti#g <br />OW by the Nebraska I~Tqautment of Rmn,.x gpbst tine sbove -named taxg4aver, is termimiled, punk% rek*Wd''ctr. subordi- <br />nated to tote extent iiaiWazed Wow. <br />'TYPE. OF A=k0N'• ; <br />Ck TERMINATION OF TAX L10J. The State Tax Lien askouby t' Ui v tir ninzted_ <br />❑ Plt011AL'RELEASE. The State Tax Lien is partially released as follows. <br />Name of party making request and responsible for tiling certificate of partial release with appropriate filing Officer. + <br />❑ SUBORDINATION. The State Tax Lien is subordinated as follows. <br />N+ma of party making request and responsible for filing certificate of subordination with appropriate filing officer. <br />l hereby certify trtat•the Nebraska Department of Revenue has Compiled with the revenue laws of the State of Nebraska in the <br />• determination of the termination. partial release or subordination Indicated above. <br />- - <br />ago <br />Taxpayers Service Specialist 1- 1G44'. <br />ynr'a u Title Date <br />' Manager 1 -10 -89 <br />utiioris <br />A d Signature TWe Date <br />. FOR COUNTY OFFICIAL'S USE <br />` <br />'i <br />NSGRASKA DEPARTMENT OF-RE UE - White and Canary Copies.. TARPA -YER - P1nk.Comc.,_ -_GQUUT-Y.OFFICE - Goldenrod Coov <br />- <br />THE ATTACHED NOTICES) OF TAR LIEN,(ETR TERMINATION) IS (ARE) TO BE FILED ONLY WITH' <br />THE •RDGISTER Pte' DEEDS. <br />THE DOCUMMT (S) IS (ARE) NOT TO BE FORWAS•tDF.D TD •TILE •COUNTY CLERK. <br />� <br />DISTRIBUTION fit?' COPIEss - <br />WHI2�E't • TO BE VALIDXTM lily THE REGIST2R OF DEEDS AND RITr'UP•EIED TO THE <br />DEPARTMENT OF PMEjjUF -. <br />GOLDENRODS TO BE KEPT BY THE REGISTI:R Or : iEEDS. <br />BILLING IS TO BE ONCE PER MC -i-PT - AND THERE WILL 'VS NO PRE- PAYMENT OF FEES. <br />(npp <br />• lA <br />TIIANK YOU FOR YOUR COOPERATION. <br />4� <br />