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PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />20201©264 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2012001262-4 Pages: 1 <br />Debtor Name: JESSE W FRANCIS <br />Filing Date and Time: 12/30/2020 12:17 PM <br />a « State Tax Lien Statement of Termination or <br />i EVENIE Certificate of Partial Release or <br />_w_....�..._..... Subordination <br />PLEASE 00 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 Identfication Number <br />26765713 <br />Federal Identification Number <br />Social Security Number <br />XXX -XX -1704 <br />Spouse's Social Security Number <br />Lien Serial Number <br />12058833 <br />Lien filled with Register of Deeds <br />Dale of Lien <br />07/24/2020 <br />Tax Category <br />22 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />JESSE W FRANCIS <br />2720 W CHARLES ST <br />GRAND ISLAND NE 68803 <br />Type of AcUon <br />®TERMINATION OF TAX LIEN. The State Tax Len is hereby fully terminated. <br />TAX YEARS 2015 <br />(corporate, Individual income, and withholding tax only) <br />UCC Instrument Number 20070011252 <br />County Instrument Number 202005410 <br />Continuance: UCC Instrument Number <br />Continuance: County Instrument Number <br />❑ PARTIAL RELEASE. The State Tax Lan 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 follows. <br />UCC Instrument Number <br />County Instrument Number <br />sign <br />here <br />I hereby certify that the Nebraska Department of Revenue has ccetplNW with the revenue laws of the State of Nebraska in <br />determination of the termination. partial release. or subordmabon indicated above. <br />Revenue Agent 12/21/2020 (308)632-1208 <br />Title Date Telephone Number <br />Revenue Supervisor 12/21/2020 <br />Title Date <br />x 23245 Rn 696 Soon.. 4.23249 R.e 1045 <br />