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NE Sec of State - Robert B. Evnen <br />Filing Document #: 2112000058-5 <br />Debtor Name: MARILYN R HAVERLUCK <br />Filing Date and Time: 12/01/2021 10:33 AM <br />Pages: 1 <br />2021102_00 <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 Identification Number <br />39016986 <br />Federal Identification Number <br />Social Sawrily Number <br />XXX -XX -4184 <br />Spouse's Social Security Number <br />Lien Serial Number <br />Date of Lien <br />Tax Category <br />County <br />12173892 <br />Lien teed with Register of Deeds <br />05/18/2021 <br />22 <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAIUNO ADDRESS <br />MARILYN R HAVERLUCK <br />222 W 6TH ST <br />GRAND ISLAND NE 68801 <br />yps of Action <br />® TERMINATION OF TAX LEN. The State Tax Lien is hereby fully temtinated. <br />TAX YEARS 2017 <br />(corporate, individual inane, and withholding tax only) <br />UCC Instrument Number 21050010476 <br />County Instrument Number 202104375 <br />Continuance: UCC Instrument Number <br />Continuance: County Instrument Number <br />El PARTIAL RELEASE. The State Tax lien 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 />I hereby certify that the Nebraska Department of Revenue has complied with the revenue Iowa of the State of Nebraska in <br />determination of the termination. partial rebase. or subordination indicated above. <br />sign ��y, , ger Revenue Agent 11232021 (402)471-5833 <br />here Preparer's Signature Tae <br />A2,4&i <br />Date Telephone Number <br />Revenue Supervisor 11/23/2021 <br />Authorized Signature Title Date <br />4.23246 Rcv. 496 SnperNM! 4-23249 Rev. 1046 <br />