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15. 2017 3:18FM NE Secretary c,f State — UCC <br />STATE TAX LIEN n NEBRASKA DEPARTMENT OF LABOR <br />• TERMINATION <br />Employer or <br />Liable Person: John Belle= <br />Address: 3111 College St. Apt 80 Grand Island NE 68803 <br />NDOL Acct. No.: 0305419007 <br />Federal JD No. / SSA No.: xxx -xx -7512 <br />This TERMINATION NATION serves to remove the lien described below and the priority of the Nebraska Department of Labor on the <br />affected property of this employer or person. This Termination is filed pursuant to Neb. Rev. Stat. § §48 -657, 48- 660.01, 48 -664, <br />and the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. §77 -3901, et seq.). <br />FULL Termination <br />PARTIAL Release <br />Property description (ONLY if PARTIAL Release): <br />n/ <br />Rate: September 15, 2017 By: <br />RETURN FILED COPIES TO: Nebr. Dept. of Labor - LEGAL <br />P.O. Box 94600 <br />201706270 <br />LIEN TO BE TERMINATED: <br />JOHN H. ALBIN <br />Commissioner of Labor <br />NDOL Serial No.: LAB -0428 -2012 <br />State Tax Lien Document No.: 9912702272 -6 <br />County: Hall <br />County Document Filing No.: 0812009283 <br />Other Filing Information: Orig. Filed Co. November 2, <br />2012 @ 1:01 PM # 201209283 <br />1 certify that the Nebraska Department of Labor has complied with the Employment Security Law of the State of Nebraska <br />in the determination of the amount due, and the employer or person has failed to pay the amount due after demand. <br />dke <br />1tATIE S. THURBER, Agency General Counsel <br />T:\ DOCUMir NTS\FORMS■.icns \Termination.docx THOMAS A. 1.TKINSKCT, Legal Counsel <br />N10,1940 F. 3 <br />E Sac of Stain Jahn A Gal r UtC TVA <br />9917798082 - asQ <br />BELLAMY JOHN <br />Filed: 09116/2017 02 :49 PM <br />NDOL Office of Legal Counsel <br />P.O. Box 94600 <br />Lincoln, NE 68509 -4600 <br />Telephone - (402) 471 -9912 <br />FAX - (402) 471 -9917 <br />NEBR. DEPT. OP LABOR <br />CHARGE ACCT. #14765 <br />