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07/1./12002 10:49 FAX 14024714429 NEBRASKA UCC 2004/005 <br />20020'7416 <br />tr State Tax Lien Statement of Termination <br />or (Certificate of Partial Release or <br />department Subordination <br />of rwenue <br />Pursuant to the revenue laws of the State or 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 terminated, <br />partially released, or subordinated to the extent indicated below. <br />Number 1 Tan Category I Sxim Sacurm/ or <br />Lien serial NUMb it Lien Rted with <br />,, ,„ , r»,a � Register of Coeds ❑County Cterx <br />NAME AND <br />Name IName <br />Str9etAOOress Street or other Ma ling Address <br />?q2 N WHEELFR <br />Clry Slate Zip Code Gay State z Code <br />�� GRAND ISLAND NE .cent <br />TION OFAX LIEN. The State Tax Lien is hereby fully Iettninated. INSTRUMENT <br />Individual Income, antl withholding tax only) �,pgj41 6Z"13 <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 />l 3 SUBORDINATION. The State Tex Lien is subordinated as follows. INSTRUMENT NUMBER <br />Please return to: - <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />Nun of party malting request and responsible for fling conificate ofpmtial roleaao w subordination with appropnatafi lingo ficar <br />. <br />I hereby cerfify het the Nebraska Department of Rwenuo has compliw with the rauenue laws of the State of Netmsia In the d etermination ct the <br />tarmmalion, parea'. release, or subordination indicated above <br />sign c�j J., � 2- 3, <br />here preparar'asignatur Date TelepnonaIN <br />tir f _z v <br />e1e <br />C <br />NEBRASKA DEPAR E Of REYENU Whits and Canary Copses TAXPAYER -Pink Copy COUNTY OFFICE Goldenrod c PY <br />4.232.11B Rev. a.96 Supa'sedea 4 -232 ea Flay. 1C Si <br />