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07/03!2001 09:28 FAY 14024714429 ]NEBRASKA LCC <br />20.010653$ <br />,firr <br />MlHSSka .. — <br />af nvnu• <br />Zo05 /OOF <br />State Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />Subordinatlon <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Pursuant to the revenue laws of the State of Nebraska, notice Is bereby <br />given that the State Tax Lien whieb 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 Identlfleatlon Number Tex Catecrory Soda] Security OT Federal I.D. Number 6pou9 e's Social Security Number <br />39475328 22 464 -37 -2502 <br />Lien Serial Number Uen Flied With Date of Uen Courtly <br />991480014 ® liegister of Deeds ❑ County clerk 07-07-99 HALL <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br />PATRICIA ROMERO <br />Street Address Street or Other Mailing Address <br />3842 OLD W HWY 30 <br />City Stata ZSp Code City Stale Zip Code <br />GRAND ISLAND NE 68801 <br />TYPE OF ACTION <br />®TERMINATION O� TAX LIEN. The State Tax Lien is hereby fully terininated. INSTRUMENT NUMBER <br />TAX YEARS {corporate, Individual Income, and withholding tax only) 19 9 4 & 1995 q "�00J�j <br />PARTIAL FELEASE. 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 />— Plea�etsturu w: <br />_ STATE OF NEBRASKA <br />DEPARTMENT OF REVEWUE <br />1811 WEST !"I' ST STE 460 <br />GRAND ISLAND NE 68803 <br />Name of party rnakir>g request and responsible tol flllitg certificate of partial release or aubordxnadon with R,proprlate filing officer <br />termination, <br />sign <br />here Prep a <br />VD- 5 <br />Vacy <br />orized <br />NEBRASKA DEPAR <br />Department of Revenue has complied with the revenue laws Df the State of Nebraska In the determination of the <br />ation indicated above. <br />AIT <br />WxOr 47Z <br />Title a Telephone NO. <br />Title <br />White and Canary Copioo TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy <br />M2 249 Rev. 69a Super 4-232-66 Frn+. 10-95 <br />