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03/08/2004 09:27 FAX 14024714429 NEBRASKA UCC 002/003 <br />Or <br />nebraska <br />department <br />of revenue <br />To* <br />200402168 <br />j - <br />2004 03:10 PM <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />TER_ M-114ATION OF:.STATE TAX LIEN <br />INDIVIMAL INCIjNE TAX <br />IF YOU INQUIRE ABM)T YOUR <br />ACCOUNTv REFER TO THESE MMBERS: <br />SOC* SECO "130 512704029 <br />NERR. IDENT- Ada. 23253.530 <br />SPOUSE SaC- SEC- xa. 5eeeeeq* <br />TAX"LE YEAR f 997 e 1998 DANA J fiw~E+* 4--PETERSON <br />LlEm m. 10 0 10 0-76 2SPOaS419�- fe-=rT223 522- -E DIVIS104 57- <br />LIEN RELEASE We 056 z44 GRAND ISLAND NE .68801 <br />COUNTY HALL <br />P1 <br />DATE'' OF. NOT14 E <br />INSTRUMENT No: UC <br />C r- <br />INSTRUMENT NO CTY <br />PURSUANT To THE- REVENUE LAWS OF THE STATE OF NEBRASKAY NOTICE IS <br />HEREBY GIVER BY THE NEBRASM DEPARTMEW OF REVENUE -THAT THE <br />STATE TAX LIEN WHUH-HAS BEEN 'DULY FILED AGAIPST THE ABOVE 'NAMED <br />TAXPAYER FOR INDIVIDUAL INC OM TAXES- IS'TERIqINATEDs <br />I HEREBY CERTIFY THAT THE NEBRASKA DEPARTMENT OF REVENUE HAS CWWLITD <br />WITH T14E REVENUE LAWS OF THE STATE OF NEBRASKA IN T-AE.DETERNINAITION-.0F <br />THIS TERMINATICNe. <br />34-0 <br />on <br />TITLE DATE <br />X IGNA ?PR P E:tf.S ATURE <br />*vim ip 0 /Ow 9 2 120400046 lf541 40 18 12 060 00 0 <br />THCRl S IGINATURE TITLE ATF <br />PLEASE 'RETAIN THIS NOWICE WITH YOUR PERMAKUT RECORDS. <br />NEBRASKA DEPARTMENT OF REVENUE — White and Canary Copies TAXPAYER — Pink Copy <br />Printed with say ink on =yded paper <br />7-145-1979 Rev. 2-2D00 Supersadas 7-146-lM Rev. 10-1995 <br />