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<br />~ 0021003
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<br />08/11/2006 16:24 FAX 14024714429
<br />
<br />NEBRASKA Dee
<br />
<br />200607189
<br />
<br />1111111111
<br />
<br />
<br />99064&15325-8 PIlS: 1
<br />QUIROZ JUAN 1'\
<br />Filed: 08/11/2006 011:24 AM
<br />Please Return Original Copy to the
<br />Nebraska Dept of Revenue at 200
<br />South Silber, North Platte, NE
<br />69101
<br />
<br />~
<br />
<br />State Tax Lien Statement of Termination
<br />or Certificate' of Partial Release or
<br />Subordination
<br />
<br />If
<br />
<br />~--
<br />dtpQlklrDlli
<br />of~'
<br />
<br /> PLEASE DO NOT WRITE IN THIS SPACE
<br />Pursuant to the revenue laws of the State,of Nebraska" nC?tlce is hereby
<br />given that the State Tax, Lien which has 6eeftduJyfiled .by",the Nebraska., ~ . ..
<br />Department of Revenue against the ~elow~named taxpayer, is
<br />tenninated, partially released, or subordinated to the ~xtent indicated -
<br />below.
<br />Nebra5ka Identification Number Federalldentiflcatlon Number Social Security Number Spouse's Social 'Security Number
<br /> 38880784 553-55-3965
<br />UBn Serial Number Lien filed with ' Date of Lien Tax Category County
<br />1-, /. 208,1 0057 '''',' .-! -~. '.. ~:ReQis~er of !;'leads 0 County Clerk 08/23/2002 , 22 HALL
<br />,;-' . .. ~ ~_ _, ,\~ . .::~, ,.1. ..., '. .' . -~. -. ,"
<br />r ,BUSlliiess NAME AND LOCATION ADDRESS ." TAXPAYER .NAME A~D MAILING ADDRESS:~;':::;;:'::''':' ~:;.:,'
<br />BusinessName' :!,,::.: " , ,-, Name,
<br /> ..
<br /> '.- j~~:':-I ;'; - .' .. : ' ' , , "JUAN M QUIROZ
<br /> "
<br /> , r .. .- : .- .. , " '.. \ '
<br />Street Address , ," Street or Mailing Address
<br /> I. .' " ' , , " ' ,
<br /> 403' E. 2ND ST
<br />City State Zip Code City State ,Zip Code
<br /> GRAND ISLAND NE 68801
<br />I ' . I, - Type of AcUon 1
<br /> ,,' -"
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<br />[Z]: "TERMiNATION OF TAx l.IEN. The State Tax Lien is hereby fully terminated. UCC Instrument Number d90223~: 7 ),
<br />
<br />County Instrument Number 200209182
<br />TAX YEARS (corporate. individual incqme, and withholding tax only) 19971998
<br />
<br />0:-, PARTlALRELEASE. The State Tax Lien ,Is partially released as folloWS: UCC lristrument Number
<br />
<br />County Instrument Number
<br />
<br />TA?<.YEARS (corporate, Individual Income, and withholding tax only)
<br />
<br />o SUBORDINATION.
<br />
<br />.
<br />The State Tax Lien is subordinated as follows.
<br />
<br />UCC Instrument Number
<br />County Instrument Number
<br />
<br />"
<br />
<br />
<br />:'.3.08 ,535--8294 "-
<br />Telephone Number
<br />"F-~-.tie:
<br />
<br />Date ,
<br />4-232-68 Rev. &-96 Suporsedeo 4-232~9 Rev. 10-95
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