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09/24/2004 15:07 FAX 14024714429 NEBRASKA UCC <br />2004094,62 <br />Ir <br />nebraska <br />department <br />ofrevenue <br />R002/005 <br />Notice of State Tax Lien <br />PLEASE DO NOT WRITE IN THIS SPACE <br />TER741 ATIDN LIT STATE TAX LIEN <br />OiDTYIDUALL INCOME TAX <br />IF YOU INQUIRE ABOUT . Y-OUR <br />ACCOU fTv REFER TO THESE. NUMBERS: <br />Saco SEC. Nom. <br />N B1Ra 'IDENT. NDo <br />SPOUSE SUC, SEC. <br />TAXABLE YEAR <br />LIEN HG. <br />LIEN RELEASE NOS <br />CGUNTY ' <br />DATE DF NOTICE <br />22605894 <br />NO- 5068A6794 <br />a;z0&i ZQ0z THOMAS P $ KAREN METTENDRINK <br />03 -04.56 -1-77 1324 V NORTH FRONT ST <br />0422 ^758 GRAND ISLAND HE 68801 <br />HALL <br />,X3 §a g <br />INSTRUMENT NO. UCC <br />IHSTRUNE%€`. NO. C TY <br />PURSUANT TU THE REVENUE LAWS 10F THE STATE UP HEBRAS;KAT NOTICE IS <br />HEREBY GIVEN BY THE NEBRASKA DEP,ARTHENT:0P REVENUE THAT THE <br />STATE TANG LIEN WHICH HAS BEEN DULY FILED AGAINST THE ABUVE NAMED <br />TAXPAYER FOR INDIVIDUAL INCME TAXES IS TERMINATED. <br />I HEREBY <br />WITH THE <br />3,415 TERI <br />r <br />CERTIFY THAT THE NEBRASKA CEPARTNENT OF REVENUE HAS ECT LIED <br />R5VENW– LAWS OF THE STATE OF NEBRASKA ' Ike THE DETERMINATION OF <br />I.IUN. <br />RPPARERTS SIGNATURE <br />;• <br />UT;I ORIZED SIGNATURE <br />'r."i'liLs s s •isaw• <br />TITLE <br />.sr..arssr: r.rrw....s <br />TITLE <br />g 4 Y14W o v <br />DATE <br />BATE <br />;PLEASE RETAIN € HIS NOTICE WITH YVUR PERMANENT RECURDS. <br />NEBRASKA DEPARTMENT OF REVENUE — White and Canary Copies TAXPAYER — Pink Copy <br />Printed with soy ink on recycled paper 7- 145 -1979 Rev- 2 -2000 Supersedes 7- 145 -1879 Rev. 10 -1995 <br />