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202201181
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2/14/2022 4:19:51 PM
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2/14/2022 4:19:51 PM
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202201181
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11110111111111111111 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2202000700-3 <br />Debtor Name: SERGIO DOMINGUEZ <br />Filing Date and Time: 02/14/2022 10:23 AM <br />Pages: 1 <br />N.ir.ake W�NMMMM <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 />94789541 <br />Federal Identification umber <br />Social SPavity Number <br />XXX -XX -5880 <br />Spouse's Social Security Number <br />XXX -XX -1990 <br />Lien Serial Number <br />Date of Lien <br />Tax Category <br />County <br />12060385 <br />Lien filed with Register of Deeds <br />08/24/2020 <br />22 <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />SERGIO DOMINGUEZ <br />CLAUDIA J GONZALEZ ORTIZ <br />2323 BELLWOOD DR APT 75 <br />GRAND ISLAND NE 68801 <br />Type of Action <br />® TERMINATION OF TAX LIEN. The State Tax Lien is hereby to y terminated. <br />TAX YEARS 2016 <br />(corporate, individual Income, and withholding tax only) <br />UCC Instrument Number 20080010322 <br />County Instrument Number 202006383 <br />Continuance: UCC Instrument Number <br />Continuance: County Instrument Number <br />❑ PARTIAL RELEASE. The State Tax Lien is partially released as fellows:. <br />TAX YEARS <br />(corporate, individual income, and withholding tax only) <br />UCC Instrument Number <br />County Instrument Number <br />SUBOROINATION. 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 complied with the revenue laws of the State of Nebraska in <br />determination of the termination, penial release, or subordination inc caaated above. <br />YRevenue Agent 02/10/2022 <br />(308)632-1203 <br />P�:- 4 f •narsttjJ Title Date TelephoneNunber <br />y17�s Revenue Supervisor 02/10/2022 <br />Signalj4' Title Date <br />4232.68 Rev 8418 Supersedes 4.212.49 Rev 10-95 <br />
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