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F. <br />1 <br />State Tax Lien <br />Staten Ot of Termination or <br />quWar— »' <br />Garth <br />BLS ow Per[m <br />Kewme or w11DOrwwoon <br />L;*n S*Tla/ Numb** <br />Document serlat <br />Date of Lien <br />Social Security Number. or <br />Number <br />01-1!L-78 <br />Fetteral l.b. Numbitr <br />�r 104753 <br />Nebraska I.D. Number <br />County <br />n Fired wltn <br />st>oYSe's Social Security <br />�,RNlater of oNda <br />NYtnper <br />1656999 <br />1 Hall <br />10 County Clerk <br />tIt1SINt.SS <br />NAME AND LOCATION <br />ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Suiln*ea Name <br />Name . <br />22210an Cafe <br />Patricia Ulu <br />Street Address <br />Street or Other Mailing Add" <br />City <br />Stn *.w <br />Zip Code <br />City State Zip Code <br />Doai ban <br />NE <br />68832 <br />Doni han NE <br />Fttrxmt to the revenue laws of the State of Nebra:Ia, notice is hereby. given that the State Tax Lien which bas been duty <br />Ned by the Ne mWw Department of Revenue aping the above named taxpayer. is terminated, partially released. or wbordi- <br />toted m Ike extent indicated bdfiowr. <br />TYPE OF ACTION <br />IN TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. <br />U PARTIAL RELEASE The State Tax Lien is partially released as follows. <br />Name of party maklrtg1Cquest anC -.FW- aosible for filing Certificate of partial relea4L with appropriate filing officet. <br />SUBORDINA'110k. The Stale Tax Lien is subordinated as follows. <br />Name of party making re4uest and responsible for mimeo Certificate of subordination with appropriate filing officer. <br />C " t her0ti ''rlortify that the Nebraska Department of Revenue has compiled witlf ?he rev*114A? L.4Ivi of the State of Nebraska In the <br />s+..' determin.l;(ct; of the termination. partial release or suborainatlon InoiUted above. <br />da- <br />.��, Revenue A6ent <br />;:he at's lure Title Date <br />Q <br />v n rE AQent Strn ry our % -�47 <br />Au'th.,Il.d Slpnate.0 Title Date <br />f:rR:90UNTY OFFICIAL' S USO <br />NEBRASKA (DEPARTMENT OF REVENUE - White alhl lrinlxV Copies TAXPAYOV » Pink Copy COUINTY.OFFICE - Goldenrod Copy <br />'!Mt< M"T 111MCM) CW TAX LI)MI (OR TMUPATION) IS:. (ARE) TO BE FILED MU 'VIM. <br />IM #MOEN" Cr <br />?Hi D CUMT(S) IS (ARE) HOT TO BE FORWARDED TO THE COUNTY CLERK. <br />D18=111 r1'ION OF COPIES: <br />MH1T»: TO BE VALIDATED BY THE =ISTER OF DEEDS AND RETURNED TO THE <br />L DEPARTMENT OF REVENUE. <br />GOLDENRODs TO BE DEPT BY THE REGISTER OF DEEDS. <br />BILLING IS TO BE ONCE PER HMTH AND THERE WILL BE NO PRE - PAYMENT OF FEES. <br />THANK YOU FOR YOUR COOPERATION* <br />E� <br />i� <br />I' <br />