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NIRA A- <br />C nncr Lle. Great Sec ce. <br />.....rnoir ..w...v, <br />2119403515 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2407000714-9 Pages: 1 <br />Debtor Name: PHILIP HAM <br />Filing Date and Time: 07/26/2024 09:33 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 />12140139 <br />Federal iD Number <br />474081838 <br />Social Security Number <br />XXX -XX -2926 <br />Spouse's Social Security Number <br />Lien Serial Number <br />12422972 <br />Lien Filed With <br />Secretary of State, Register of Deeds <br />Dale of Lien <br />03/13/2024 <br />Tex Program <br />1 <br />County <br />HALL <br />( Business Name and Location Address <br />Taxpayer Name and Mailing Address <br />J <br />PHILIP HAM <br />118 WEST 11TH STREET <br />GRAND ISLAND NE 68801 <br />Tax Years 2021 <br />UCC Instrument Number 2403000692-2 <br />County Instrument Number 202401197 <br />Type of Action <br />® Termination of Tax <br />Lien <br />The State Tax Lien is hereby fully terminated. <br />i hereby certify nut the Nebraska Department of Revenue hes Complied with the laws Of the Stale of Nebraska in determination of the <br />contima$bon, t do Vparbal release, or aubord;nation indicated above. <br />parer's Signature <br />theressyaarofausnki nebraska�a gov <br />bflma 0[ "') L <br />Authorized Signature <br />Revenue Senior Agent 07/09/2024 (402)595-2247 <br />Onto Phone Number <br />Tale <br />Revenue Senior Agent <br />Title Date l�c+r3° <br />4433-t9$11 Nev. 540111 <br />Supt0W51154432•166/ Rev.1.2013 <br />