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PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2002001274-2 Pages: 1 <br />Debtor Name: JOSE POL VELASQUEZ <br />Filing Dale and Time: 02/28/2020 11:27 AM <br />202001340 <br />�,,a, ky State Tax Lien Statement of Termination or <br />REVENUE Certificate of Partial Release or <br />Subordination <br />PLEASE DO NOT WRITE IN 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 filed 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 :der ficalion Number <br />96588195 <br />Federal Identification Number <br />Social Security Number <br />XXX -XX -0738 <br />Spouse's Swat SeCurity Number <br />Lren Serial Number <br />11793686 <br />Lien filed with Register of Deeds <br />Date of Lien <br />09/11/2017 <br />Tax Category <br />22 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />JOSE POL VELASQUEZ <br />409 W 5TH ST <br />GRAND ISLAND NE 68801 <br />Type of Action <br />® TERMINATION OP TAX LIEN. The State Tax Lien is hereby fully terminated <br />TAX YEARS 2015 <br />(corporate, individual income, and withholding tax only) <br />UCC Instrument Nu>Zber 90177980485_,, <br />County Instrument Number 20170E257 <br />Continuance: UCC Instrument Number <br />Continuance: County Instrument Number <br />El PARTIAL RELEASE. The State Tax Lien is partially 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 is subordinated as fellows <br />UCC Instrument Number <br />County Instrument Number <br />sign <br />here <br />I hereby certifyitial use Nebraska Department of Revenue has cronp`wt.)ied 1 Ilse revenue laws of the State of Nebraska in <br />delermiral } the termination, partial release. or subcrdnation iroaceted above. <br />Revenue Senior Agent 02/20/2020 (308)632.1205 <br />Title pate Telephone Number <br />i'L'lJufv hA/re /4f <br />02/20/2020 <br />Title Date <br />J 1.2.2-B8Rnr 8.%S.ia.w5e1 4. 32-81) Ryy 17-45 <br />