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10/17/2001 16:29 FAX 14024714429 NEBRASKA <br />200110531 <br />1005/009 <br />ME foe oT Skai• - I{CC Taf <br />1 <br />99 1172 2: 1 <br />PURKE 0 CLARE <br />F1. led: 1011712001 03:12 PM <br />State Tax Lien Statement of Termination <br />Or m or Certificate of Partial Aelease or <br />rww "u Subordination <br />- -- -- _ <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Pursuant to the revenge laws of the State of Nebraska, notice is hereby <br />given that the State Tax Lien which has been dnly Sed by the Nebraska <br />Department of Revenue against the below -named taxpayer, is terminated, <br />pkrtlally released, or subordinated to the extent indicated below. <br />Nebraska ldentiAcationNumber <br />Tex Category <br />Social Security tx Federal LD,Numoer <br />Spouse's SodalSecud Number <br />29948193 <br />22 <br />505 -64 -3485 <br />215 -40 -5537 <br />ion Serial Number <br />Lien Filed With <br />Date of Lien <br />CO <br />88239080 <br />[73 Ro ster of Deeds ❑ County Clerk <br />09-13-89 <br />H ALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND NAILING ADDRESS <br />Business Name <br />BERT A & G CLARE BURICE <br />Street Address <br />Strrtglq�9th04r,hlp�Og,�fr BLVD <br />1�L`� <br />City State DpCoee <br />City State T <br />GRAND ISLAND NE 6 01 <br />TYPE OF AcnoN <br />\EQ TERMINATION O TAX UEN. The State Tax Lien is hereby fully terminated, INSTRUMENT NUMBER <br />RS (corporate, Individual Income, and withholding tax only) 1987 & 19881 n <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 />DEPARThffiNT OF REVENUE <br />- 1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />Name of parry matting request and responsible lot Sting cenffloate o1 partial release or subordination with approprietefilIng officer. <br />I hereby comity that the Nebraska Depanment of Revenue has complied with the revenue laws of the State of Nabraska in the determination of the <br />termination, parial release, or subordination indicated above, <br />sign <br />here repa.s r Title Date f Telephone No. <br />Da Dd <br />ail Title s <br />NEBRASKA DEPA OF REVENU - White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy <br />4.23248 Rev. & per <br />99 Suffd" 4 -02.0e R -. 111 <br />