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r <br />State Tax Lien <br />�rnee.awe. Statement of Termination or <br />�SeeihMU1 uerTITIcate <br />of Partial <br />Release or Subordination <br />Lien Serial Number <br />Document Serial <br />Number <br />Date of Lien <br />Sochi! Sircurity Number or <br />Federal I.D. Number <br />9' <br />i.0 108 <br />12401 <br />10 -28 -83 <br />505 -50 -9386 <br />JL 012 Q 1 <br />Ntbraske I.D. Number <br />County <br />cLien Filed With <br />Register Creeds <br />Spouse's Social Security <br />2751360 <br />Hall <br />Y of <br />J:j county clerk <br />Number <br />RSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Susiness Name <br />Name <br />Safari Bar 8 Lnungs" <br />G- Johnston <br />Str"t Address <br />106 East 2nd Strelif <br />Street or other Mailing Address <br />City State <br />Grand Island, NE <br />Zip Coda . <br />68801: ." <br />City State Zipcede <br />Island, fit 6880 <br />Pursuant to the revenue laws of the State of Nebraska, wjdke is hereby given that, the- Sl W., tax Lien which has been duly <br />filed by the NebraAa Department of Revenue agahtst the 8hoase'mi m- 4 tLxpayer, is trrcm saWd, Or rt*y released, or subordi- <br />mted to the extent indicated below. <br />xi TE RIMiNAZIOU46F TAX LIEN. The State Tax Lien #iW hi:irb� ti ilia :�•rtnina[ed. <br />t?ART1AL RELE' ASE. The State Tar Lien is partialb ti 1. j! is follows. <br />Name of party making request writ responsible for filing certifica`r_ hf partial release •f+ith appropriate filing officer. <br />SUBORIDWAtiON. The State Tax Lien is subordinated as follows. <br />Name of party making request and responsible for filing certificate of subordination with appropriate filing officer. <br />hereby certify tit ;f the %eCraska nepartmki:t of Revenue has compiled with the revenue laws of the State of Nebraska In the <br />determination of triof,grnlnatinn, partial release w r .i:bordination Indicated abnve. <br />sign J <br />Taxpayers Service S pecialist <br />kere Pr ssig re Title Date <br />Revenue Agent Supervisor g 4 -(f ► <br />Aut.:.�►IZ Signature Title Date <br />. i. <br />FOR COUNTY OFFICIAL'S USE <br />NEBRASKA DEPARTMENT OF REVENUE Vihite and Canary Copies TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy <br />4.232.68 Rev. 5.86 <br />Supersedes 4232.68 Rev. 2.81 <br />17 l_ <br />17 <br />