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C 0( L;to. circ -at 52rvtce. <br />202303080 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2306000497-7 Pages: 1 <br />Debtor Name: LISA LAROSA <br />Filing Date and Time: 06/21/2023 10:42 AM <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 />35454024 <br />Federal i0 Number <br />Social Security Number <br />XXX -XX -3668 <br />Spouse's Social Security Number <br />Lien Serial Number <br />12317319 <br />Lien Flied With <br />Secretary of State, Register of Ikeda <br />Date of Lien <br />01/10/2023 <br />Tex Program <br />22 <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />USA LAROSA <br />3800 HADLEY DR <br />NORTH PLATTE NE 69101 <br />Tac Years 2018 <br />1.1CC Instrument Number 23010006101 County instrument Number 202300257 <br />k <br />f<I <br />Type of Action <br />1"ermination of Tax The State Tax Lien is hereby fully terminated. <br />Lien <br />I hereby certify that the Nebraska Department of Revenue has complied with the laws 01 the State of Nebraska in determination of the <br />continuation, termination, partial release. or subordination indicated above. <br />Revenue Agent 06/13/2023 (402)471-5916 <br />,Preparers Signature Title Dale Phone Number <br />sherri.nelson®nebraska.gov <br />Email Address <br />zed Signatuje <br />Revenue Supervisor 06/13/2023 <br />Title Data <br />4-232.1968 Rev. 8-201e <br />Supersedes 4-232-15613 Rev. 1-2015 <br />