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03/04/2002 17:58 FAX 14024714429 NEBRASKA L'CC 2004,,005 <br />Please forward to: <br />Nebraska Depanment of Revenue <br />4500 Avenue I PQ Box 1500 <br />Scottsbluff, INE 69363 -1500 <br />200202444 <br />Or State Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />Otbrakt <br />et,w"at Subordination <br />arrnee. <br />PLEASE OO 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 />Departmental! Revenue against the below -named taxpayer,ts terminated, <br />partially released, or subordinated to the extent Indicated below. <br />Nebraska ldentalcallon NW'Tber <br />Tax Category <br />Social$Kuril" Federal l.C. Number <br />Spouse% Social Security Number <br />38609312 <br />22 <br />568 -76 -0263 <br />Lien Serial Number <br />Lien Filed WIM <br />Date of Lien <br />County <br />961240277 <br />®fiaeiatwofOeeds pCOLnfyclerk <br />06/16/1996 <br />[call <br />BUSINESS NAME AND LOCATION ADDRESS <br />rAXPAYER NAME AND MAILING ADDRESS <br />Busnees Name <br />Name <br />Justin L Hawkins <br />Straat Addreas <br />Street or Other Wing Address <br />PO <br />PO Box 770 <br />Ory State <br />7�p COCe <br />Cry <br />cup Cptle <br />Hunt' on OT <br />84528 <br />/ 1, TYPE OF ACTION <br />T <br />®TERM{NATION OF AX LIEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER Ct !) 96- 105037 <br />orporate, Individual Income, and withholding tax only) 1987, 1988 , 3989, t 05037 <br />❑ PARTIAL RELEASE, The State Tax lien is partially released as follows, INSTRUMENT NUMBER <br />TAX YEARS (corporate, lndhridual 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 carthicate of partial release or Subordination Win appropriate fir n8 ofecer. <br />Ih Cy certtty tna Nebraska Departmera of Revenue has complied with the revenue laws cfthe State of Nebraska In the tlaterMnaedn ofam <br />term) ,� release, su ationl cared abeva <br />Si fl 13081632 -1200 <br />here Pr DY <br />Tel PhD N0 <br />�. Revenue Supervisor llvNi /C7?! <br />OF REVENUE - White and Canary Ccpies <br />9 <br />TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod COPY tM <br />4.s,-Gap.. aa6 SupYteha 4232 -sa RN. 10-95 <br />