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-05/1112003 12:31 FAX 14024714429 <br />e <br />NEBRASKA UCC <br />12002 <br />NI S.. of ik.ke - Ucc T @I <br />99032a9ON Fos: 1 <br />CHAVEZ JOSE L <br />Filed: 011/11!2003 10 W Pm <br />200310449 <br />State Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />Subordination <br />PLEASE DO 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 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 <br />Tax Category <br />Federal identification Number <br />Social Security Number <br />34735747 <br />22 <br />0 t5 -61-914 4Z <br />645 -01 -9621 <br />Lien Serial Number <br />Lien filed with <br />Date of Lien <br />County <br />22140-456 <br />xZ Register of Deeds ❑ County Clerk <br />11/2012002 <br />Hall <br />BUSINESS NAME AND LOCATION ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />Name <br />Jose & Deborah L Green Chavez <br />Street Address <br />Street or Mailing Address <br />208 Cardinal Dr <br />City <br />State Zip Code <br />City State Zip Code <br />Grand Island lebrask 68803 <br />Type of Actio n <br />0 TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. <br />TAX YEARS (corporate, individual Income, and withholding tax only) <br />UCC Instrument Number gVW-7 � <br />County Instrument Number 200212562 <br />2000.2001 <br />PARTIAL RELEASE. The State Tax Lien is partially released as follows: <br />TAX YEARS (corporate, individual Income, and withholding tax only) <br />UCC Instrument Number <br />County Instrument Number <br />❑ SUBORDINATION. The State Tax Lien is subordinated as follows. <br />UCC Instrument Number <br />County Instrument Number <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in <br />dete 'nation of the ter ' tion, partial rel ase, or subordination indicated above. <br />Sign 1110. .,� Revenue Agent 08/04/2003 402 471 -5835 <br />here Pre s 5i ire Title Date Telephone Number <br />)I- Revenue Agent Sr 08104/2003 <br />Authorized Signature Title Date <br />1� <br />M 5 <br />