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�`- 4!10 + +.••� <br />�1: t <br />�tPOt <br />State Tax Lien <br />r tee' Statement of Termination or <br />Lion Serial Number <br />Certificate of Partial Release or Subordination <br />Document Serial Date')? Lien g <br />NAIMCar �tiat Security Number or <br />4/02/605 12403 2 -3 -84 Federal I.D. Number $�.4.� 01 <br />Nebraska 1.0 . Number County. Lien Filed With s —ci g `� ��Jt <br />Register Of DMIS Numenor Social Security <br />2751380 Hall County Clark <br />BUSINESS NAME AND LOCATION ADDRESS <br />Business Name TAXPAYER It1Alt�EAr,ID t14Af LING ADDRESS <br />Name <br />Safari Bar & Laura a Ver1fe G. Johnston <br />sttc:t:Fxr9ess <br />7f� East 2nd Street Street CcrerPAailing gdtlress <br />City 803 S.ftady . Bend Road <br />State Zlp Coda City <br />Grand..Island NE State Zip Code <br />68801 Grand. Island, NE 68801 <br />Funtiant to the revenue taws of the State of Nebraska notice is hvac :& -ten that the State Tax ,Lien which hasOo� -i duly <br />filed by the Nebraska Department of Revenue against the above noted W;17zYer. is terminated. partially released, dr. i�tk+�rdi. <br />nated to the'extent indicated below. <br />TYPE nF ANION <br />Qi TERMINATION OF TAX LI&C -The State Tax Lien is hereby fully terminated. <br />❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows. <br />Name of party making request and responsible for tiling certificate of partial release 011th appropriate filing officer. <br />❑ SUBORDINATION. The State Tax Lied b; oibordinated as follow;. <br />Name of party making ralueEt and re n:rnsible for filing Certificate of subordlrlation svlth appropriate finny officer. <br />1 hereby certify tnat IYe Nebraska Department of Rave.jue 11 t, Gtripiled vrrnr tll" reya;nuo laws Of the State al Nebraska in the <br />determination of the termination, partial release or subnrdiaattun it, it leas above. <br />sign <br />hire <br />Authorlxed Signature <br />Taxnavew; Set•vit;e SilP�faT #st <br />'tle <br />evenue Agen . 5upery i sor <br />t H1r <br />s <br />NEBRASKA DEPARTMENT OF REVENUE �J1,itea d Canary Copies TAXPAYEk _ Pint; Copy <br />L - L <br />t <br />Date <br />Date <br />COUNTYOFFICE GaldenruJCbpy <br />4- 23Z -68 Rev. 5.86 <br />Supersedes 4.232.68 Rev. 1.81 <br />J <br />S ' <br />n <br />.Z <br />i <br />. r�v <br />r- r: <br />r <br />