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12/08/2000 13:45 FAX 14024714429 <br />NEBRASKA UCC <br />IM 002/002 <br />f �dl�l� f�lf� �IIIllullilNl IIIlI Illlllil <br />99610101449 Fes 1 <br />ROBERSON r,ERRIE <br />FLimd 12!08!2000 10 50 AM <br />200010(9$ <br />OrState Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />apart "' Subordination <br />depsren4nt <br />ar rfwnue <br />TYPE OF AC71ON <br />ERTERMINATION OF TAX LIEN. The State Tax Lien is hereby Fully terrninaled. INSTRUMENT NUMBER 96"102679 04 -11 -96 <br />TAX YEARS (corporate, Individual Income, and withholding tax only) <br />❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMBER <br />TAX YEARS (corporate, Individual income, and withholding tax only) <br />❑SUBORDINATION. The State Tax Lien is subordinated as follows. INSTRUMENT NUMBER <br />Please return to: <br />STATE OF'NEBRASKA <br />DEPARTMENT OF REVEI TM <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />Name of party making request and responsible fortiling certtflcate of partial release or subordination with appropriate filing officer. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Pursuant to the revenue laws of the State of Nebraska, notice is hereby <br />I hereby certify that the Nebraska Department of Reversie has complied with the reverue laws of the State of Nebraska In the determination of the <br />given that the State Tax Lien which has been duly filed by the Nebraska <br />termination, partial raleas orsubo imton Indicated above. <br />Department of Revenue against the below -named taxpayer, Is terminated, <br />partially released, or subordinated to the extent Indicated below. <br />Nebraska Identification Number <br />Tax Category <br />Social Security or Federal 1, D. Number <br />Speuse'a Social Security Number <br />3372669 <br />01 <br />507 -70 -0862 <br />Len Serial Number <br />Lien Filed With <br />Date of Len <br />County <br />6/04/389 <br />ReglaterofDeeds ❑County Clerk <br />04- 09 -96. <br />HAIL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />(3ERRIE RDBERSCk7 <br />Street Address <br />Street or Other Mailing Address <br />2917 W STOLLEY PARK RD <br />city State Zip Coda <br />city State ap Code <br />GRAND ISLAND NE 68801 <br />TYPE OF AC71ON <br />ERTERMINATION OF TAX LIEN. The State Tax Lien is hereby Fully terrninaled. INSTRUMENT NUMBER 96"102679 04 -11 -96 <br />TAX YEARS (corporate, Individual Income, and withholding tax only) <br />❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMBER <br />TAX YEARS (corporate, Individual income, and withholding tax only) <br />❑SUBORDINATION. The State Tax Lien is subordinated as follows. INSTRUMENT NUMBER <br />Please return to: <br />STATE OF'NEBRASKA <br />DEPARTMENT OF REVEI TM <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />Name of party making request and responsible fortiling certtflcate of partial release or subordination with appropriate filing officer. <br />I hereby certify that the Nebraska Department of Reversie has complied with the reverue laws of the State of Nebraska In the determination of the <br />termination, partial raleas orsubo imton Indicated above. <br />sign <br />Oal� ov <br />.p1111501Z <br />here <br />Preparer's Sqnshare Title_ <br />/Date <br />Telephone <br />7m C9 <br />oraed Sig Title <br />Dale <br />NEBRASKA DEPARTMENT OF REVENUE - White and Canary Copies <br />TAXPAYER - Pink Copy COUNTY DFF10E - Goldenrod Copy <br />4 -23288 Rev. 8.96 Supersedes 4- 232-68 Rev. 10 -95 C <br />