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<br />11/23/2005 17:08 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />IgJ 002 <br /> <br />OCb <br /> <br />, Please return 10: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />200511644 <br /> <br />111""1\' <br />99054Z3S'15-9 <br />~~~~~ m~?2g06 10,60 AI'I <br /> <br />, <br />/ <br /> <br />II <br />_r <br /> <br /> <br />State Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />Subordination <br /> <br />l'IIlbIUllll <br />d1~nm~ <br />l)(~ <br /> <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 Federal Identification Number Social Security Number Spouse's Social Security Number <br /> 9066950 459-33-3843 <br />Lien Serial Number Lien filed'with Date of Lien Tax Category County <br /> 04/12/34;3 T~l~e:~is~e~,;of ,Deeds 0 County Clerk 12/03/2004 01 I Hall <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Teresa D .Urbina <br />Street Address Street or Mailing Address <br /> 2903 WStolley Park Road <br />City State Zip Code City State Zip Code <br /> Grand Island NE 68801 <br />r Type of Action I <br /> <br />~ TERMINATION OF TAX LIEN. The State Tax Lien is hereby tully terminated. <br /> <br />uec Instrument Number ~~~ <br />County Instrument Number 200411845 <br /> <br />. T...X YEARS (corPorate, Individual Income, end withholding tax only) <br /> <br />D PARTIAL RELEASE. <br /> <br />The State Tax .Lien Is partially released as follows: <br /> <br />. uee Instrument Number <br />County Instrument Number <br /> <br />TAX YEARS (corporate, individual Income, and withholding tax only) <br /> <br />o SUBORDINATION. <br /> <br />The State Tax Lien is subordinated as follows. <br /> <br />UCC Instrument Number <br />County ,Instrument Number <br /> <br />sign .. <br />here <br />... <br /> <br /> <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 te ination, partial release. or subordination indicated above. <br /> <br />REVENUE SUPERVISe ~/Ios- 308 385-6067 <br />Title te / Telephone Number <br /> <br />REVENUE SUPERVISOR // h / /o~ <br />Tille Dafe ' <br />4-232-6B Rev. B-96 Supersedes 4-232-69 Rev. 10-95 <br /> <br />~D <br /> <br />\, <br /> <br />\ <br />