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04/07/2005 09:08 FAX 14024714429 NEBRASKA UCC Ij003 /005 V 200503067 Hit S" of stsis LOPEZ Filyd 2006 02109 PM State Tax Lien Statement of Termination or Certificate of Partial Release or Subordination PLEASE DO NOT WRITE IN THIS SPACE Pursuant to the revenue laws of the State of Nebraska, notice is hereby given that the State Tax Lien which has been duly filed by the Nebraska Department of Revenue against the below -named taxpayer, Is terminated, partially released, or subordinated to the extent indicated below. Nebraska Identification Number Federal Identification Number Social Security Number Spouse's Social Security Number 6490557 449- 25-4680 Lien Serial Number Lien filed with bate of Lien Tax Category County 3/09/420 ❑x Register of Deeds ❑ County Clerk 9 -30 -93 1 94 Hail BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name Antonio Lopez Street Address Street or Mailing Address 1822 East 7th St City State Zip Code City State Zip Code Grand Island NE 69801 Type of Action TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated TAX YEARS (corporate, individual income, and withholding tax only) UCC Instrument Numbe 08931080: County Instrument Number 93- 108026 ❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows: UCC Instrument Number County Instrument Number TAX YEARS (corporate, Individual Income, and withholding tax only) ❑ SUBORDINATION. The State Tax Lien is subordinated as follows. UCC Instrument Number County Instrument Number I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in determination of the termination, partial release, or subordinatlon indicated above. sign 402 471 -5709 here Prep is 5igna re Title Date Telephone umber Revenue Senior Agent futhorF7967(grAture Title e SEE ATEA_HMEN__4. 232 -68 Rev - &96 Supersedes 4 -232-69 Rev, 10-95