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Ne,..EBRrA. <br />NE Sec of Statc - Robert R. Evnen <br />Filing Document #: 1910000521-3 Pages: 1 <br />Debtor Name: KHAM BANDASACK <br />Filing Date and Timc: 10/09/2019 11:22 AM <br />201906281 <br />State Tax Lien -- Statement of Continuation or <br />Termination; Certificate of Partial Release <br />or Subordination <br />Pursuant to the revenue laws of the State of Nebraska, the <br />Tax Commissioner hereby gives notice that the State Tax Lien <br />against the taxpayer identified below, the original notice of which <br />was duly filed of record as indicated, is continued, terminated, <br />partially released, or subordinated, to the extent indicated below. <br />Social Sucnnty Nu <br />XXX -XX -3192 <br />Nebra ka ID Number <br />10684611 <br />Federal In humor <br />4549/1615 <br />Please Do Not Write In This Space <br />Lien Serial Number <br />11798615 <br />Date of Lien <br />Tax <br />Secretary of State, Register of De/2/1812017 1,21 <br />Taxpayer Name and Mailing Address <br />Business Name and Location Address <br />Corg <br />11ALI. <br />Soc.a1 Srreurrty <br />KHAM 13ANDASACK <br />1416W.1ST <br />GRAND ISLAND NV 68801 <br />Tar: Years 2016 <br />UCC Instrument Nurninr 99188046147 County lnstnnne nt Nu 201800320 <br />Type of Action <br />1 <br />® - Ter- mination of Tax <br />Lien <br />The State"( Lien is hereby fully tennintned_ <br />candy 'hat the No tuus"ice (Oetiarenent of Revenue lass complied twat. fiat laws 011'1,0 Sate et N€braska Gr detn »annexe c <br />torreinatiron. eatt+.$,teyasa, w uaxrrdinatten indicated Wow.. <br />_11)/0412012...... (402)411.-5711 <br />Dee Phnno Numb.* <br />4432"`968 fees.. 84018 <br />Scrose0e, 4232.1466 NKr '_ .201S <br />