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NEDRA/Y CA - <br />Good Ute. Great Senitce. <br />202305872 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2311000159-2 Pages: 1 <br />Debtor Name: ANDREW WERTZ <br />Filing Date and Time: 11/07/2023 09:54 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 />41165683 <br />Federal ID Number <br />Social Security Number <br />XXX -XX -3365 <br />Spouse's Social Securely Number <br />Lien Serial Number <br />12181304 <br />Lien Filed With <br />Secretary of State, Register of Deeds <br />Date of Lien <br />09/22/2021 <br />Tax Program <br />22 <br />County <br />HALL <br />Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />ANDREW WERTZ <br />1041 S LOCUST <br />GRAND ISLAND NE 68801 <br />Tax Years 2018 <br />UCC Instrument Number 21090013275 <br />County Instrument Number 202108268 <br />Type of Action <br />® Termination of Tax <br />Lien <br />The State Tax Lien is hereby fully terminated. <br />I hereby certify that the Nebraska Department of Revenue has complied with the Imes of The State of Nebraska in determination of the <br />continuation. termination, partial release, or subordination Indicated above.. <br />Revenue Agent 11/02/2023 (402)471-5712 <br />,Preparefs Signature Title <br />chris.dittmar6nebraska.cov <br />Dab Phone Number <br />Email Address <br />Revenue Supervisor 11/02/2023 <br />Tale <br />Date <br />4-232-teee Rev. e-2o1e <br />et:persedes 6232-1968 Rev. 1-f 019 <br />