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IES <br />G.,,cd Li`e Gel Sew:ce_ <br />0.101.04.1 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2212000996-5 Pages: 1 <br />Debtor Name: TIFFANY PENDERGRAFT <br />Filing Date and Time: 12/28/2022 09:12 AM <br />202208869 <br />State Tax Lien — Statement of Continuation or <br />Termination; Certificate of Partial Release <br />or Subordination <br />Pursuant to the revenue laws of the State of Nebraska, the <br />Tax Commissioner hereby gives notice that the State Tax Lien <br />against the taxpayer identified below, the original notice of which <br />was duly filed of record as indicated, is continued, terminated, <br />partially released, or subordinated, to the extent indicated below. <br />Please Do Not write In This space <br />Nebraska ID Number <br />11458097 <br />Federal ID Number <br />461817825 <br />Social Security Muller <br />XXX -XX -1795 <br />Spouse's Social Security Number <br />Lien Sorb) Number <br />12212689 <br />Lien Filed With <br />Secretory of State, Register of Deeds <br />Dated Lien <br />10/26/2022 <br />las Program <br />21 <br />County <br />HALL <br />1 Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />j <br />TIFFANY PENDERGRAFT <br />3126 WESTSIDE ST <br />GRAND ISLAND NE 68803 <br />Tax Years 2020 <br />UCC Instrument Number 2211000145-0 <br />County Instrument Number 202207872 <br />Type of Action <br />® Termination of Tax <br />Lien <br />The 'tate'lox Lien is hereby fully terminated. <br />t hereby certify that the Nebraska Department of Revenue has complied witn the taws of the Mate of Nebraska in determination of Nle <br />coMinaation. mnnin8 00 partial release. Or subOrrl4tation Indicated above. <br />+� LkOu^ ��Revenlle Agent 1212117022 L402)471=5717 <br />Date Phone Number <br />parer s Signature Tate <br />rebeceLward Jnehaaska gov <br />Email Adgmal <br />10'Auttorized Sigi <br />Revenue Sit ptrvisnr <br />11110 Date <br />4.232.1568 Rev. 8.2018 <br />gvgraW0S 4.232.1068 Pew. 1-2015 <br />