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PLEASE RETURN TO: <br />NEBRASKA DEPT OF REVENUE <br />PO BOX 94609 <br />LINCOLN NE 68509-4609 <br />11111111111111111111111111111111111111111111111111111 <br />11111111 <br />202100797 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2101001368-0 Pages: 1 <br />Debtor Name: IBETH INIGUEZ <br />Filing Date and Time: 01/29/2021 11:42 AM <br />,,arbrosits <br />;, 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 Idenbftcation Number <br />99460955 <br />Federal Identification Number <br />Social Security Number <br />XXX -XX -4446 <br />Spouse's Social Security Number <br />Lien Serial Number <br />11934622 <br />Lien filed with Register of Deeds <br />Date of Lien <br />07/30/2019 <br />Tax Category <br />22 <br />County <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />IBETH INIGUEZ <br />416 W CHARLES ST <br />GRAND ISLAND NE 68801 <br />Type of Action <br />El TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. <br />TAX YEARS 2016, 2017, 20t8 <br />(corporate, individual Income, and withholding tax only) <br />UCC Instrument Number 19080002284 <br />County Instrument Number 201904667 <br />Continuance: UCC Instrument Number <br />Continuance: County Instrument Number <br />0 PARTIAL RELEASE. The State Tax Lien ,s 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 />I hereby certify that the Nebraska Department of Revenue has comp ed with the revenue laws of the State of Nebraska in <br />determination of the termination, partial releaseor stbordinaton ndica!ed above. <br />sign Revenue Agent 01/08/2021 (308)632-1206 <br />here Preparers <br />Honature <br />Title Date Telephone Number <br />Revenue Supervisor 01/08/2021 <br />Tide Date <br /><,23i 66 R.v. 6 66 Smrsrsmmm• 4,232.e9 Rev 1.3.95 <br />