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04/10/2002 12:01 FAX 14024714429 N I NEBRASKA UCC IM003 !E so",F•ei in - UGC - TN I 4 i i f 9902208196 -4 Pas: t MOLINA JOSE A FILed: 04/10/2002 11:78 Aft State Tax Lien Statement of Termination Or or Certificate of Partial Release or rleareate -' Subordination 1N revenue TYPE OF ACTION ZTERMiNATIO OF TAX LIEN. The State Tax Lien Is hereby fully terminated. INSTRUMENT NUMBE 4 corporate, individual income, and withholding tax only) 99-108579 0 8- 2 6- 9 9 ❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMWA TAX YEARS (corporate, Individual Income, and withholding tax only) ❑ SUBORDINATION. The State Tax Lien Is subordinated as follows. INSTRUMENT NUMBER — Please rel to: STATE OF NEBRASKA — DEPARTMENT OF REVENUE _ 1811 WEST 21 D ST STE 460 GRAND ISLAND NE 68803 Name of party making request avid responsible for Sing certificate of paraal release or subordktation with appropriate Ning ofilcer. 1 hereby certify thatthe Nebraska Departmeri of Revenue MPIW with the revenue laws oftrle State of Nebraska in the determination of the termination ltlaI slow , or subofnstion indicated abow . sign e.� here eparere ignatura T Date IelephonaNO. AuCarl2ed Title %— e 1 NEBRASi64 DEPARTME REVENUE - White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy l� 423ZO 9ev, 8-96 supersedes 4-232-Oa Rev. 10 -95 PLEASE DO NOT WRITE IN THS SPACE Pursuant to the revenue laws of the State of Nebraska, notice is hereby ,Tax given that the State Lien which has been duly Died by the Nebraska Department of Revenue against the below -named taxpayer, is terminated, 2 p 0 2 0 3 9.4 4 partially released, or subordinated to the extent indicated below. Nebraska identificoon Number Tax Category Social Security or Federal I.D. Number Spouses Social Security Number 8129851 01 620 -16 -3167 Lian Serial Number lien Rled With Cal of Uen County, 9 /08/391 ® Register of heeds ❑ Coumy clerk 08-20-99 HALL BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name JOSE A MOLINA Street Address, street or Other Maling Address 421 S MADISON City state Zip Code City State Zip Code GRAND ISLAND NE 68801 TYPE OF ACTION ZTERMiNATIO OF TAX LIEN. The State Tax Lien Is hereby fully terminated. INSTRUMENT NUMBE 4 corporate, individual income, and withholding tax only) 99-108579 0 8- 2 6- 9 9 ❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMWA TAX YEARS (corporate, Individual Income, and withholding tax only) ❑ SUBORDINATION. The State Tax Lien Is subordinated as follows. INSTRUMENT NUMBER — Please rel to: STATE OF NEBRASKA — DEPARTMENT OF REVENUE _ 1811 WEST 21 D ST STE 460 GRAND ISLAND NE 68803 Name of party making request avid responsible for Sing certificate of paraal release or subordktation with appropriate Ning ofilcer. 1 hereby certify thatthe Nebraska Departmeri of Revenue MPIW with the revenue laws oftrle State of Nebraska in the determination of the termination ltlaI slow , or subofnstion indicated abow . sign e.� here eparere ignatura T Date IelephonaNO. AuCarl2ed Title %— e 1 NEBRASi64 DEPARTME REVENUE - White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy l� 423ZO 9ev, 8-96 supersedes 4-232-Oa Rev. 10 -95