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NK-A- <br />Cs:v,+J L.re Great Sera :e. <br />20200560s <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2008000013-0 Pages: 1 <br />Debtor Name: RANDY DACK <br />Filing Date and Time: 08/03/2020 10:52 AM <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 Tiled of record as indicated, is continued, terminated, <br />partially released, or subordinated, to the extent indicated below. <br />Please Do Not Write In This Space <br />Nebraska ID Number <br />8696500 <br />Lion Serial Number <br />11944537 <br />Federal ID Number <br />Social Security Number <br />XXX -XX -4143 <br />Spouse's Social Security Number <br />Lien Filed With <br />Secretary of State, Register of Deeds <br />Date ol Lien <br />12/05/2019 <br />L <br />Business Name and Location Address <br />County <br />HALL <br />Taxleyer Name and Mailing Address <br />Tax Program <br />1 <br />RANDY DACK <br />112 CAMPBELL <br />DONIPHAN NE 68832 <br />'I ax Years 2018 <br />UCC Instrument Number 19120010693 <br />County Instrument Number 201908027 <br />Type of Action <br />Termination of Tax <br />lien <br />The State Tax Lien is hereby fully terminated. <br />I hereby earthy that the Nebraska Department of Revenue has complied with the laws of tow Slate of Nebraska in determination ol the <br />continuation, termination, partial release, or subordination indicated above. <br />Aeeacs,-GG!ox -i%atzazt Revenue Agent 07;2812020 (402)471-5717 <br />preparers Signature Title Date Rhone Number <br />rebecca ward@nebraaka,ptry <br />Email Address <br />'Authorized Signature <br />Revenue Senior Agent <br />nae <br />7-28-2020 <br />Date 4232.1968 Rev. &2D18 <br />Supersedes 4232-196e Pay. 1.2515 <br />