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_..12/15/2000 11:08 FAX 14024714429 NEBRASKA UCC [a004/005 <br />NG Su• .i G�.�. - UCC U9 <br />_ IIIII Ill Illllilllllllllllllllilllilllil <br />9900102828 Pys: t <br />HOWARD CONNIE k <br />Filed 7217512000 09:29 Rr <br />Or <br />nebreeke <br />daperenent <br />of reYMue <br />200010875 <br />State Tax Lien Statement of Termination <br />or 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 Bled by the Nebraska <br />Department orRevenue against the below -named taxpeyer, is terminated, <br />partially released, "or subordinated to the extent indicated below. <br />Nebraska Identification Number <br />Tau Category <br />Social Security or Federal 1. D. NUrnner <br />Spouse's Social Security Number <br />19448819 <br />22 <br />512 -70 -0461 <br />Lien Serial Number <br />Lien Filed With <br />Dace of Lion <br />County <br />171 7 1 01 85 <br />X] Register of Deeds ❑ County Clerk <br />08/08/1997 <br />Hall <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS —A <br />sucinasc rv.ms <br />Name <br />Connie K Howard <br />Street Address <br />Street or Other WaWN Address <br />3924 Old Vineyard Rd A t. 106 <br />City State <br />Zip Coda <br />Ctry Staff 27p Code <br />Winston Salem NC 27104 <br />TYPE OF ACTION r <br />TION pF TAX UEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER QtV # <br />YEARS 0orporate, Individual income, and withholding tax only) <br />❑ PA LEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMBER <br />TAX YEARS (Corporate, Individual Income, and withholding tax only) <br />C SUBORDINATION. The State Tax Lien is subordinated as follows. INSTRUMENT NUMBER <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff NE 69363 -1500 <br />Name of parry making request and responsible for fling certificate of partial release or subordination wlttl appropriate filing oftker- <br />I hereby certify that the Nebraska Department of Revems has compiled wtr the revenue laws of the State of Nebraska in the determination of the <br />terrrwlation, rtiat release, orsubonlinatan Indicated above. �_ �� /� <br />sign Reverlu�Acxent / //3 1"-)t) _Cio81632 -1200 <br />here Pre arer' a Date Telephonallo <br />g Revenue Anent S1ervitsor <br />uthorized Signatur Title <br />NERRkSKA DEPARTMENT OF REVENUE • White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy <br />4-232.w Fkw. a.9e Supersedes 4292 -02 Rev- t 0.0 <br />