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12/20/2001 15:40 FAX 14024714429 NEBRASKA LCC IM003/004 <br />c' see .r 24. +s - ucc to@ <br />9901184630 -5 Pas: 1 <br />ELLISON THOMAS R <br />riled, 12120/2001 12:51 PM <br />200113194 <br />State Tax Lien Statement of Termination <br />Ir or Certificate of Partial Release or <br />nraDnska <br />department Subordination <br />orr"~wue <br />I ' TYPE OF ACTION -�.. <br />ZTERMINAATTIOONN QF'TAX LIEN. The State Tax Lien is Peroty fully terr.,iratee. INSTRUMENT NUMBS g0118 1 825 —�f <br />nARS (corporate, Individual Income, and withholding tax only) <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 />Please return 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 makng request and responsible for NWQ certificate of partial release or subordktatlon with appropriate fling ofAcer <br />I hereby certify that the Nebraska Department of Revenue has plted wnh the revenue laws of the State of Nebraska In the determination of the <br />termination, partial relea . or su ordination IntllCated above. <br />sign <br />here Prepafe'691gnatU a �� bete Telephon No. <br />uthorizedSi r Title' �Da <br />NEBRASKA DEPA RTMENT OF REVENUE - White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFIpy <br />4232 -68 Flex. 8-96 Supereadae A -232Ba Rey. 10-95 <br />1 <br />3 <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 -named taxpayer, is terminated, <br />partially released, or subordinated to the extent indicated below. <br />Nebraska Nerd fication Number <br />Tax Category <br />Social Security or Federal I.D. Number Spouse's Social Security Number <br />6317995 <br />01 <br />506 -70 -9266 <br />Lien Serial Number <br />Lien Filed With <br />Date of Liar I County <br />01/12/315 <br />N Register of Daads ❑ County Clerk <br />11/30/01 HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Narne <br />Name <br />THOMAS R ELLISON <br />StraetAddress <br />Stmetor Other Mailing Adaress <br />311 W 15TH ST <br />City State Zip Code <br />~1� <br />City Stata Zip Code <br />GRAND ISLAND NE 68801 <br />I ' TYPE OF ACTION -�.. <br />ZTERMINAATTIOONN QF'TAX LIEN. The State Tax Lien is Peroty fully terr.,iratee. INSTRUMENT NUMBS g0118 1 825 —�f <br />nARS (corporate, Individual Income, and withholding tax only) <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 />Please return 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 makng request and responsible for NWQ certificate of partial release or subordktatlon with appropriate fling ofAcer <br />I hereby certify that the Nebraska Department of Revenue has plted wnh the revenue laws of the State of Nebraska In the determination of the <br />termination, partial relea . or su ordination IntllCated above. <br />sign <br />here Prepafe'691gnatU a �� bete Telephon No. <br />uthorizedSi r Title' �Da <br />NEBRASKA DEPA RTMENT OF REVENUE - White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFIpy <br />4232 -68 Flex. 8-96 Supereadae A -232Ba Rey. 10-95 <br />1 <br />3 <br />