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201906630 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 1910001559-3 Pages: 1 <br />Debtor Name: DEREK L KERMOADE <br />Filing Date and Time: 10/24/2019 11:27 AM <br />PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />,�,,,t• <br />a ; State Tax Lien Statement of Termination or <br />REVENUE Certificate of Partial Release or <br />Subordination <br />PLEASE DO NOT N/RITE 'N THIS SPACE <br />Pursuant to the revenue laws of the State of Nebraska, notice is hereby <br />given that the State Tax Lien which has been duly riled by the Nebraska <br />Department of Revenue against the below -named taxpayer, is <br />terminated, partially released, or subordinated to the extent indicated <br />below. <br />Nebraska Identification Number <br />Federal Identification Number <br />Soda! Seculty Number <br />Spouse's Social Security Number <br />40710998 <br />XXX -XX -8212 <br />XXX -XX -7860 <br />Lien Serial Number <br />Date of Len <br />Tax Category <br />County <br />11928036 <br />Lien filed with Register of Deeds <br />04/30/2019 <br />22 <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />DEREK L KERMOADE <br />LAURA L ZMEK <br />1124 S PINE ST <br />GRAND ISLAND NE 68801 <br />Type of Action <br />® TERMINATION OF TAX LIEN. The State Tax Lien ,s hereby fuNy terminated <br />TAX YEARS 2017 <br />(corporate, individual income, and withholding tax only) <br />UCC Instrument Number 19050005752 <br />County Instrument Number 201902644 <br />Continuance: UCC Instrument Number <br />Continuance: County Instrument Number <br />0 PARTIAL RELEASE The Stale Tax s pa Bally released as follows <br />TAX YEARS <br />(corporate, Individual Income, and withholding tax only) <br />UCC Instrument Number <br />County Instrument Number <br />0 SUBORDINATION. The State Tax Lien s subordinated as follows <br />UCC Instrument Number <br />County Instrument Number <br />sign <br />here <br />1 hereby certify that the Nebraska Department of Revenue has oompied with the revenue laws of the State of Nebraska in <br />ceterrrination of the termination, aa 'al release. or subordination indicated above. <br />Revenue Agent 10/21/2019 (308)632-1203 <br />Title Cate Telephone Number <br />Revenue Supervisor 10/21/2019 <br />Title <br />Date <br />a 232,th Rev t 56 Sopersexs 4-D2-59 R. t3-95 <br />