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NE Sec of State - Roben B. Even <br />Filing Document #: 2207000124-4 Pages: 1 <br />Debtor Name: JANN N DANIELSON <br />Filing Date and Time: 07/05/2022 09:38 AM <br />State Tax Lien Statement of Termination or <br />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 />30628172 <br />Federal Identification Number <br />Social Security Number <br />XXX -XX -8140 <br />Spouse's Social Security Number <br />Lien Serie Number <br />Date 01 Lien <br />Tax Category <br />County <br />12287601 <br />Lien filed with Register of Deeds <br />01/03/2022 <br />22 <br />HALL <br />I BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILINO ADDRESS <br />JANN N DANIELSON <br />510 WEST KOENIG STREET <br />GRAND ISLAND NE 68801 <br />Type of Action <br />TERMINATION OF TAX UEN. The State Tax Lien is hereby kitty terminated. <br />TAX YEARS 2014, 2015, 2016, 2017, 2018, 2019 <br />(corporate, Individual income, and withholding tax only) <br />UCC Instrument Number 22010003336 <br />County instrument Number 202200173 <br />Continuance: UCC Instrument Number <br />Continuance: County Instrument Number <br />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 />❑ 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 complied with the revenue laws of the State of Nebraska In <br />determination of the termination, partial release, or subordination indicated above. <br />,t% L aI Revenue Agent 06/29/2022 (308)632-1201 <br />Preperer's Signature Title Date Telephone Number <br />,t%t¢�¢. Revenue Supervisor 06/29/2022 <br />Authorized Signature Title Date <br />4-23248 Ren 8.96 Supersedes 423245 Rev. 10.95 <br />