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01,1612003 L6:00 FAX 14024714429 —NEBRASKA UCC <br />0'i <br />B on a: 004 <br />_ <br />"141 e cIp <br />NI90 1IItl 'PII������Fpplyy {yN��I� '''1'1''' nip„ ayIllflulll ''I,II1pr1T''F1111erlr <br />DZ fi- "° 1111"11 <br />FIIW "Matter Ix. 16 Pll r. <br />20030$241 <br />I <br />y, State Tax Lien Statement of Termination <br />r or Certificate of Partial Release or <br />Subordination N� <br />` PLEASE DO NOT WRITE IN THIS SPACE <br />Z <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 <br />terminated, partially released, or subordinated to the extant indicated <br />below. <br />Nebraska ldenlificatbn Number <br />T. Cebgory <br />Social 5ecuny Number <br />Souses Soch Secielty Number <br />8682 <br />21 <br />505-0&8493 <br />a <br />Lan Sanl Number <br />Gen Nw <br />3.m of Lim <br />Cunty <br />0212239 <br />ORegsmrof Deeds [:3Courty Clerk <br />1113(1/2002 <br />HALL <br />F BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME Al NAILING ADDRESS <br />3uo ... s Name <br />Name <br />ADAM DZINGLE <br />Street Acdrese <br />Sel or sluing Mmes. <br />on : 2512 Chanticleer #7 <br />120 W 9TH ST <br />0ity Slab Zip Coca <br />City Stab ap Cade <br />GRAND ISLAND NE 68801 <br />G TERMINATION OF TAX LIEN. The Slte Tax Llei Is hereby fully terminated. UCC Imbueent Number <br />Gounty Instrument Number <br />TAX YEARS ( corporate, i ndividual Income, and withholding lex only) 2001 <br />PARTWL RELEASE. The Slb Tarr Lan upanially robasetl as POl'ows: UCC lnstmmant Number <br />County Instrument Number <br />TAX YEARS (corporeb, Indlvldual income, and withholding tas only) <br />I] SUBORDINATION, The State Talc pen ie subominated as follows. UCC Instrument Number <br />County Instrument Number <br />I hereby canny met the Ni Dwanmert of Revenue hue cumulled vvW no revenue laws of ins Sate of Neerazka In <br />deb ' ahon of Ve terminaliu i. p I masse, or"co9lna0on lydicaled above. <br />sign I". ' Revenue Seri, Agent 05/1512003 402471 -5727 <br />here 2 Sign Title Da@ Telephone Number I_ <br />Revenue Senior Agent 051l W2003 <br />A-vibbi Signature iltle Bate <br />a.zas..e a•� o-se cw7•e.• • -zaz -x ae..:cee <br />