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04/10/2002 12:01 FAX 14024714429 <br />Or <br />rlsarasaa <br />depsrta+ent <br />NEBRASKA UCC <br />r <br />ra 004 <br />Pus: I <br />F1led 04'10/2002 11.18 QX <br />State Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />Subordination <br />TYPE OF ACTION <br />[RTERMINATION O TAX LIEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBS 08484 , <br />YEA "rate, individual Income, and withholding tax only)1 999 99 110901 11- 10 -99 <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 />_ Pieasarehrmto: , <br />STATE OF NEBRASKA <br />--- DEPARTMENT OF REVENUE <br />_ 1811 WEST 2NO ST STE 460 <br />GRAND ISLAND NE 68803 <br />Name of parry making request and responsible for Bir1g certificate of partial release or subordination with appropriate fling officer. <br />I herby Certify that tha Nebraska Department of Revenue has compfiedwilh the revenue laws ofthe Stale of Nebraska In the determination of the <br />termination, I r 7041417) - bordi tndicated above. <br />sign �.. <br />e-14Wa'UP Qia'PA; � <br />4,� _ <br />Preae3 8gnare 4f Dat. Telapfbn here <br />t -{� <br />COUNTY OFFICE - Goldenrod Copy <br />4-4324M Rw, 546 Supwsedst 4-M44 film, 10 -06 <br />and Canary Copies TAXPAYER - Pink Copy <br />PLEASE 00 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 Len which has been duly filed by the Nebraska <br />Department ofRevenue against the below-named taxpayer, is terminated, <br />200203945 <br />partially released, or subordinated to the extent indicated below. <br />Nebraska Identification Number <br />Tax Category <br />Social Security or Federal 1. D. Number <br />Spouse's Social Security Number <br />8129851 <br />01 & 21 <br />620 -16 -3167 <br />Lien Bartel Number <br />Lien Filed With <br />Date of Lien <br />Comw <br />9/10/348 <br />[3 Register of Deeds County Clark <br />10-31-99 - <br />HALL <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDAM <br />Business Name <br />Name <br />JOSE A MOLINA <br />Street Address <br />Street or Other Mailing Address <br />421 S MADISON <br />City �_ -� State Zip Code <br />City State Zip Code <br />` <br />GRAND ISLAND NE 68801 <br />TYPE OF ACTION <br />[RTERMINATION O TAX LIEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBS 08484 , <br />YEA "rate, individual Income, and withholding tax only)1 999 99 110901 11- 10 -99 <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 />_ Pieasarehrmto: , <br />STATE OF NEBRASKA <br />--- DEPARTMENT OF REVENUE <br />_ 1811 WEST 2NO ST STE 460 <br />GRAND ISLAND NE 68803 <br />Name of parry making request and responsible for Bir1g certificate of partial release or subordination with appropriate fling officer. <br />I herby Certify that tha Nebraska Department of Revenue has compfiedwilh the revenue laws ofthe Stale of Nebraska In the determination of the <br />termination, I r 7041417) - bordi tndicated above. <br />sign �.. <br />e-14Wa'UP Qia'PA; � <br />4,� _ <br />Preae3 8gnare 4f Dat. Telapfbn here <br />t -{� <br />COUNTY OFFICE - Goldenrod Copy <br />4-4324M Rw, 546 Supwsedst 4-M44 film, 10 -06 <br />and Canary Copies TAXPAYER - Pink Copy <br />