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10/17/2001 16:31 FAX 14024714429 NEBRASKA UCC <br />T3b <br />Or <br />nebresim <br />deparanent <br />of rnveaara <br />200110634 <br />ra009 /009 <br />State Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />Subordination <br />Pursuant to the revenue laws or the State of Nebraska, notice is hereby <br />given that the State Tax Lien which has been duly filed by the Nebraska <br />Department of Revenue against the below -namcd taxpayer, is terminated, <br />paptially released, or sabordimated to the extent indicated below. <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Nebraska IdentltfcationNUmbef <br />Tax Category <br />Social Seeuntyor Federal I . Number Spouse's Social Security Nurrmoer <br />8037884 <br />01 <br />512 -46 -2257 <br />Lien Serial Number <br />01 /09/375 <br />Uen Filed With <br />gRegi wofDeeds ❑Countycierk <br />Date of Lien County <br />09 -05 -01 HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />DANIEL M DEPOY <br />Street Address <br />Street or other Nailing Address <br />703 W 14TH <br />qty State <br />ZIP Code <br />city State ZIp Code <br />GRAND ISLAND NE 68801 <br />TYPE OF ACTION <br />� TERMINATION OF AX LIEN. The State Tax Llen is hereby fully terminated. INSTRUMENT NUMB <br />YEA rpomts, individual Income, and withholding tax only) 9901165081-9 <br />[] pARTJAL 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 />?lease retum to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST Vo ST STE 460 <br />GRAND ISLAND NE 68803 <br />Name of party making request and r;—w a ableixJUIng ea tfic to of paltlal release or subordination Whh app1op6atefiling oi5cer. <br />I hereby oar* that the Nebraska Department cf Revenue has omVl;ed with the revenue laws of the State of Nebraska in the determination of the <br />termi loo, partial release, or subordination indicated abova <br />Sig <br />hereefa to Date Telephone <br />i <br />r uet \ <br />NEB KA DEPARTMENT OF REVMN - White and Canary Copies TAXPAYER -Rink Copy COUNTY OFFICE 2 a <br />