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; <br /> i - -- <br />+ � '�. �� � �S� <br />� � _�a _�� <br />� 7 <br />, <br />� <br /> I <br />� � 99 108904 <br /> i <br />, <br /> � State Tax Lien Statement of Termination <br /> �Ir <br /> nabraska or Certificate of Partial Release or <br /> departrn�nt Subordination <br /> ot nv�nua <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 Identification Number Tax Category Social Security or Federal I.D.Number Spouse's Social Security Number <br /> 3257;9i32 27. 4,$8-33-0?.b9 <br /> Lien Serial Number Lien Filed With Date of Lien County <br /> 912 910 017 �Register of Deeds ❑co���y cie� 10-18—19 91 I��:LL <br /> BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> Business Name Name <br /> LARRY R WOOL�:Y <br /> Street Address Street or Other Mailing Address <br /> 601 PARI� AVE <br /> City State Zip Code City State Zip Code <br /> MONROE LA 71701 <br /> TYPE OF ACTION <br /> [�TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER 9 G-1010�1 & 9 2-10 0 3�1 <br /> TAX YEARS (corporate, individual income, and withholding tax only) �9�� <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 /> Name of party making request and responsible for filing certificate of partial release or subordination with appropriate filing otficer. <br /> I hereby certity that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br /> termi tion,partial release,or sut3ordination indicated above. <br /> si9n ► /i�� J�;/T�ri�l� �C l%� '�l�'�r (/� l-"!l.�l �� � j`L j � <. ;�����'_l!+!1 JL <br /> he re Pre���S Signature � ' Title Date Telephone No. <br /> � . �— -- �--� y,s' <br /> Q�� uthorized i e Title � Dat <br /> NEBRAS DEPARTME F REVENUE- hite and Canary Copies TAXPAYER-Pink Copy COUNTY OFFICE-Goldenrod Copy <br /> 4232•68 Rev.B-96 Supersedes 4-232-68 Rev.10-95 <br />