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<br />08/15/2006 16:43 FAX 14024714429 NEBRASKA Dee IaI 0021003
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<br /> 200607287 990646582'-8 PIlS . 1 '
<br /> BOYSEN ARTHUR E .
<br /> F!J.d: 09/15/2006 11:31 AM
<br /> Please Return Original Copy to the
<br /> Nebraska Dept. of Revenue at 200
<br /> South Silber, North Platte, NE
<br /> 6910 1
<br />
<br />If"
<br />
<br />l'IoI;Im~
<br />llDPlrflltDl'I4
<br />'l(19~
<br />
<br />
<br />, State Tax Lien Statement of Termination
<br />or' Certificate of Partial Release or
<br />S ubord ination
<br />
<br />PLEASE DO NOT WRITE IN THIS SPACE
<br />
<br />Pursuant to the revenue laws ofthe State of Nebraska, notlce 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 />
<br />Nebraska Identification Number
<br />33943168
<br />
<br />Lien Serial Numbe'r_ Lien filed. with
<br />"., ,
<br />
<br />, .. ',,' 434509~J cf',i,:,' ::,'; ,':.'" ~': .~~,\J~is\ter of. De~ds. .D.cpu~ty Clerk
<br />I ,." 'BUsiNE$~ft'<i~E,Aiili?:::LocATiqN'ADP~~S.S .. '..
<br />. auslnes"s 'N'am-e' . '. , " .",.. "' ---.. ,. . , . , . , .
<br />
<br />F6deralldentification Number
<br />
<br />~ociaJ Security Number
<br />481-40~3242
<br />
<br />Spouse's Social SeciJrity Numbe~
<br />482-32-9467
<br />
<br />Date of Lien Tax Category, County
<br />
<br />'12110/2004 22 HALL
<br />. ,T~PAYFR Nt\M,E;,~'WP l,t'IA!L1t<1G ADDRESS
<br />
<br />Street Address
<br />
<br />. 'I'
<br />'," r
<br />
<br />Name'
<br />ARTHUR E. & HARRIET p', BOYSEN
<br />
<br />City
<br />
<br />Slate
<br />
<br />Zip Code
<br />
<br />Streel or Mailing Address
<br />4247 VERMONT AVENUE
<br />City State
<br />GRAND ISLAND NE .
<br />Type of Action
<br />
<br />Zip Code
<br />68803 .
<br />
<br />I "
<br />
<br />fK1 TERMINATION OF TAX LIEN: The State Tax Lien is hereby fully terminated, ~CC Instrument Nu~b.r 6~9.?417 .1.95 7 _..:"')
<br />County Instrument Number 200510249
<br />
<br />--..-~- I
<br />.-.-" "'-
<br />
<br />TAX YEARS ,(corporate, indivIdual Income, and wlthh~ldlng tax. only~ 2003
<br />
<br />o PARTIAL RELEASE.
<br />
<br />The State Tax Lien Is partially released as follows:
<br />
<br />UCC:lnstrument Number
<br />County Instrument Number
<br />
<br />TAX YEARS (corporate, individual Income, and withholding tax only)
<br />
<br />o SUBORDINATION.
<br />
<br />The State Tax Lien is subordinated as follows.
<br />
<br />UCC Instrument Number
<br />County Instrument Number
<br />
<br />'.
<br />,. . .. . '-.,~ hereby.certify thaI the Nebraska.-'Department of Revenue has complied with the .revenl/e laws :of.1.l:1e Sta.te of l\Iebras'kl))n.
<br />....,". .. , di:!t ination':Ofth~ iehninaliori, partial release, 'or 5ubordin~tion Indicated above: . :'._ ::::.':',"~.'; ..-..... ",-':'" .. ',' '.u'. .- ':_,
<br />
<br />~~'gl(~ u ''-' ,....". - . . - '", 'Rev$nueAgent 'J!..9::...tJG 308' '535-8294
<br />. here' .' itla Date Telephone Number
<br />.. Revenue Supervisor F... /1-&>6.
<br />~ ~~
<br />4.232-68 Rev, 8-96 Superaede. 4.232-69 Rev. 1Q.95
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