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State Tax lien <br />�� Statement of Terndnation or <br />fGauirr" seam a+_ .as:..,.a....a n^.4:ft1 nr QalhnrrtFrafinn <br />Be IT- 1Ye <br />M4■ .....vv�v <br />- <br />-� -- - -- <br />- - - <br />Lie. Serial Number <br />Document Se`w <br />Number <br />Date Of Uen <br />socist security Nu. =�'!* or <br />Federal I.D. Number <br />g , <br />9/01/681 <br />12600 <br />1 -9 -89 <br />06 -20 -3510 <br />102122 <br />Nebraska LD. Numbaz <br />County <br />Lien Filed With <br />Register Of Deeds <br />Spouse's social Security <br />Number <br />699802 <br />Hall <br />❑ County Clerk <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND M- AILIW3 ADDRESS <br />Business Name <br />Name <br />William F. Burton <br />Street Address <br />Street or Other Malting Address <br />505 d. Stolley Park Road <br />city <br />State <br />zip coo* <br />city state ZIP Coo* <br />68801 <br />Grand Island NE <br />Pursuant to the revenue laws of the State of Nebraska. notice is hereby given that the State Tax lien winch has teen awy <br />filed by the Nebraska Department of Revenue againsd the above named taxPayer, is terminated, partially rela'sed• or subordi- <br />nated to the extent indicated below. <br />TYPE OF ACTION <br />Q TERMINATION OF TAX LIEN. The State Tate Lien is hereby fully terminated. <br />❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows. <br />Name of Party :n inc reques, and resoo,iSable for filing certificate Of Partial release with appropriate filing officer. <br />❑ SUBORDINATION. The State Tar Lien is subordinated as follows. <br />a <br />i <br />Name of party making request and responsible for filing cert HlCate of subordination with appropriate filing officer. - <br />sign <br />:heie �Wetl Slgnatu <br />1 <br />- 1 <br />•t <br />1 hereby certify that the Nebraska Department of Revenue has comolled With the revenue laws Of the Mate Of NeOr <br />determination of the termination, partial release or subordination Indicated above. <br />Taxpayers Service Specialist <br />Title Date <br />_ Revenue Agent Supervisor 4 - <br />Title Date <br />FOR COUNTY OFFICIAL' S USE <br />in the <br />I: <br />1 <br />NEBRASKA DEPARTMENT OF REVENUE - White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy <br />THE ATTACHED NOTICE(S) OF TAX LIEN (OR TERMINATION) I:; (ARE) TO BE FILED ONLY WITH <br />THE REGISTER OF D7_EDS. <br />THE DOCUMENT(S) IS (ARE) NOT TO BE FORWARDED TO TIM COUNTY CLERK- <br />._ s <br />DISTRIBUTION OF COPIES: <br />WHITE: TO BE VALIDATED BY THE REGISTER OF DEEDS AND RETURNED TO THE <br />DEPARTMENT Or RFVF.Nit". <br />GOLDENROD: Z'O BE KEPT BY THE REGISTER OF DEEDS <br />BILLING IS TO BE ONCE PER MONTH ANIi THERE WILL BE NO PRE — PAYMENT OF FEES. <br />THANK YOU FOR YOUR COOPERATION. <br />e I <br />