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06/16/2005 16:18 FAX 14024714429 NEBRASKA UCC 002 /002 <br />Please return t07 <br />STATE OF NEBRASKA <br />DEPARTNffiNT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br />offover . <br />200505479 <br />WE Seo of S4.4. - U[c Tag <br />9905399598 -5 POE: 7 <br />BASTRON KIMBERLY L <br />Filed ;'06116/2005 12 ;S7 PM <br />State Tax Lien Statement of -"..I: <br />..I:►atron :: •` <br />or Certificate of Partial Release or <br />- Subordination <br />Pursuant to the revenue laws of the State of 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 <br />terminated, partially released, or subordinated to the extent indicated <br />below. <br />Nebraska Identification Number Federal Identification Number <br />7473834 <br />Lien Serial Number Lien filed with •• <br />09/01/310 ❑X Register of Deeds, ❑ County Clerk <br />BUSINESS NAME AND LOCATION ADDRESS <br />Business Name: <br />Street Address Street or Mailing Address <br />2323 BELLWOOD DR # 88 <br />City State Zip Code City State <br />GRAND ISLAND NE <br />Type of Action <br />gl,rl,•TER,NUNAZlOf4 OF ,,TAX`LIENN. he State Tax Lien is hereby fully terminated, UCC Instrument Number <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Social Security Number Spouse's Social Security Number <br />508 -11 -4667 <br />Date of Lien Tax Category County <br />01/21199. C;z 1 Hall <br />TAXPAYER NAME AND MAILING ADDRP4S <br />IName <br />KIMBERLY L BASTRON. <br />TAX YEARS (corporate, individual Income, and withholding tax only) 1997 <br />❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows: <br />TAX YEARS (corporate, individual income, and withholding tax only) <br />❑ SUBORDINATION. The State Tax Lien is subordinated as follows. <br />ENTERED ON NUMERICAL INDEX AND RECORDED ON <br />JANUARY <br />County Instrument Number <br />UCC Instrument Number <br />County Instrument Number <br />Zip Code <br />68801 <br />HALL q- 160 76957 <br />UCC Instrument Number <br />County Instrument Number <br />1999 AS INSTRUMENT NO 99- 100785 <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in <br />determination of the ermination, partial release, or subordination indicated above. <br />sign ► REVENUE SENIOR AG r NT 06/1412005 308 385 -6073 <br />here Prepare' Sign to Title Date Telephone Number <br />REVENUE SENIOR AGENT 06/14/2005 <br />Authorized signature Title Date <br />4232 -68 Rev, 8-95 3uporsodas 4 -232 -Gg Rev. 10 -95 <br />