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— � D% <br />ip <br />Or <br />nebra ft <br />dopwoem <br />at minus <br />I <br />200110'761 <br />PM <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 filed by the Nebraska <br />Department of Revenue against the below -aa toed taxpayer, is terminated, <br />partially released, or subordinated to the extent indicated below. <br />a <br />7205546 <br />sacra✓ becunry or Federal I.D. Number Spouse's 800ie18 -wity Number <br />Oi 506 -64 -3732 <br />Uen Sedan Number Uen Flied With Data of Lien <br />01/09/391 �] Register of Deeds [] couruy Clerk 09-1 9 - 01 HALL <br />BUSINESS NAME AND <br />Business Name LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />ELITE BUSINESS CONCEPTS THOMAS P METTENBRINK <br />street Address <br />710 W 4TH ST a'r0°t m 01�r MaiUnB Address <br />1324 W NORTH FRONT ST <br />City State ap Code City State <br />_ GRAUD ISLAND NE 68801 GRAND ISLAND NE Cock <br />TYPE OF ACTION 8801 <br />TERMINATION OF AX UEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER 6— 5 <br />RS rporate, individual Income, and withholding tax only) 200109840 <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 />--mkaae .4tu n to: <br />_STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />-1811 WEST 2ND ST STE 460 <br />_GRAND ISLAND NE 68803 <br />Name of party making request wW responr.ible for tiling certificate of periial releaae or subordination with <br />appropriate }ding olilcer. <br />I hereby certify peal the Nebraska Dapertment of Flevenue has complied with the revenue laws of ate Stara of Nebraska In the determination of the <br />termination, Partial r e, or a bor&iwion indicated above. / <br />sign ��� <br />here arers tare T ,� >3�� �A -7� <br />Dote Telepho No. <br />DUL <br />odzed e T <br />NEBRASKA <br />✓trite and Canary Copies TAXPAYER - Fink Copy COUNTY OFFICE - Goldenrod Copy h, \, <br />423248 Rev. 9.96 supersedes 4.292:83 Rev. 10- <br />