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r .s44, <br />Gana _tie.: Gila rm•:ire. <br />NE Sec of Stale - Robert B. Evnen <br />Filing Document #: 2008000483-5 Pages: 1 <br />Debtor Name: RANDY DACK <br />Filing Date and Time: 08/14/2020 11:28 AM <br />202005999 <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 />Please Do Not Write In This Space <br />Nebraska ID Number <br />86965110 <br />Federal ID Number <br />Social Security Number <br />XXX -XX -4443 <br />Spouses Social Security Number <br />lien Serial Number <br />11921336 <br />Lien tiled With <br />Secretary of State, Register of Deeds <br />Date of Lien <br />01/17/2019 <br />Tax Program <br />1 <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />RANDY DACK <br />R 1. DACK HORSESHOEING & FORGE <br />112 CAMPBELL <br />DONIPHAN NE 68832 <br />Tax Years 2015, 2016, 2017 <br />t1CC Instrument Number 1901002071-9 Counts Instrument Number 201900655 <br />Type of Action <br />Termination of Tax The State Tax Lien is hereby fully terminated. <br />Lien <br />This entity is a sole proprietorship. There is no FEIN associated with it. <br />I Ninety certey that Ow Nebraska Department of Revenue has complied wan the laws of the State or Netuaalo in determination of the <br />continuation. termination, partial release, or subordination imaeaied above. <br />•, 6 C tei)a-rtoll,"PiRevenue Agent 07/28/2020 (402)471-5717 <br />Reparer's Signature Tate Dare Phone Number <br />rehecca wardfq nebranka.grty <br />€yell Address <br />.-41.44•4•-"-) Revenue Senior AEenf <br />I1Au .xed� Title <br />7-28-2020 <br />Date <br />4-232•' 868 Rev. 8-2018 <br />Sutv455555 55.232-'984 her. 1-20 15 <br />