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06/08/2005 08:52 FAX 14024714429 NEBRASKA UCC f� 002/003 a 200505180 fes of Sie4e - ACC Two 9906398056 -6 Pas: 1 BUSTGIC CHERYL Filed: 06107/2005 03:48 PM State Tax Lien Statement of OF nati0 or Certificate of Partial Release or Subordination 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 70666648 485 -52 -1460 50864 -3344 Lien Serial Number Lien filed with Date of Lien Tax Category County 013130013 ❑K Register of Deeds ❑ County Clerk 01/0412002 22 Hall BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Business Name Name Denzel R & Cheryl Busick Street Address Street or Mailing Address 3027 Brentwood Place City State Zip Code City State Zip Code Grand Island NE 68801 Type of Action 7ERMMATL0N OF WHEN; The State Tax Lien is hereby fully terminated. UCC Instrument Number 99021$70726 a County Instrument Number 201)200217 TAX YEARS (corporate, individual income, and withholding tax only) 1998,1999,2000 ❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows: UCC Instrum t N b TAX YEARS (corporate, individual income, and withholding tax only) ❑ SUBORDINATION. The State Tax Lien is subordinated as follows. en um or County Instrument Number 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 subordination indicated above. sign 402 595 -2070 here proper, Signature ` Title Date fiefs hon Number Revenue Senior Agent Authari ed Signature Title Dat h .r`