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<br />11/13/2006 17:14 FAX 14024714429
<br />
<br />NEBRASKA Dee
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<br />1aI 003/003
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<br />200610166
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<br />1IIII1111I1
<br />
<br />
<br />9986479920-6 Pgl: 1
<br />FLOREZ CHRISTINE 1'1
<br />Fil.d: 11/13/200601:46 AN
<br />Please Return origfu~ Copy to the
<br />Nebraska Dept. of Revenue at 200'
<br />South Silber, North Platte, NE
<br />69101
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<br />State Tax Lien Statement of Termination
<br />or Certificate of Partial 'Release or
<br />Subordination
<br />
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<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 ha,"lieeri'duiy1ifett-bythevNebraska-.-n
<br />Department:of Revenue against the' below-riamed taxpayer, is
<br />terminated, partially released, or subordinated to the extent indicated
<br />below.
<br />Nebraska IdentificaUon Number Federal Identification 'Number Social Security Number Spouse'~ Social Security Number
<br /> 34001603 505-82-5875 506-04-7518
<br />Lien Serjal Number Uen filed with . Date of Lien Tax Category County
<br /> 524502~~ i . [~lRegiSler of O~~dS.O County Clerk 09/02/2005 "'HALL'.. --
<br /> '. .. '. ' .- ,;
<br />L 'BUSINESS'NAMEAND,LbcATION ADDRESS' : . . .. TAXPAYER NAME AND MAILING ADDRESS - .
<br /> . .
<br />Business.Name . .- j - I,: ; _:'.' .' ":;"" , '.:', ~ .: ,I", " II ;_ ',~ . ., -, ,- Name -, ,- '-.- . "'" ."~i;"'I" _ . .~I.,..;
<br />. .~ -, . . .
<br /> ,", "THOMAS B. g: CHRISTINE'M: FLOREZ' -:: .
<br /> . '~'I'... .~_
<br /> .. . .., .. .
<br />.Slr(let Adciress.. ., ......, Street or Mailing Address
<br /> .. ,- 1922 W NO~TH F.RONT ST
<br /> ..
<br />City State Zip Code City State Zip Code
<br /> GRAND ISLAND NE 68803
<br />I' Type of Action J
<br />00 : TERMINAnON QF TAX LIEN, The State Tax Lien Is hereby fully terminated. UCC Instrument Number ~06465328 4)
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<br />County Instrument Number 200607190
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<br />TAX YEARS (corporate, Individual income, and wl~holdlng tall'only) _ 2004
<br />D PARTIAL RELEASE. The Slale Tax LiBn is.partially released as follows:
<br />
<br />TAX YEARS (corporate. individual Income, and withholding tax only)
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<br />UCC Instrument Number
<br />County Instrument Number
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<br />o SUBORDINATION.
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<br />The Slale Tax Lien is subordinated as follows.
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<br />UCC Instrument Number
<br />County Instrument Number
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<br />sign ..
<br />:, here'
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<br />I hereby_ certify .thiilt the .,N!'Ibralika. D~part_ment of Revenue has complied with the revenue laws of the Slate of Nebraska in
<br />de ination of-the teJ;min"tiQn;paT!lal're.ieas~J. or !iubordlnation iridicaled above. .~ ,.... -: '_" -...-..:... ~"_._"__'" ..:, . :::~._ .: . _". '. .... __.
<br />.-' ..-. - - -- -- '. Revenue Agent ':":/t'-t;. ~.",.-, ,<:.~.::' ..... -'. 308'~'535:'8294-'
<br />Tille Date Telephone Number
<br />Revenue Supervisor /U---,t tI .
<br />.~re ~ O~
<br />4-232-Ei8 R,v. 8-96 Sup.roedeo +232-69 R.~, 10-95
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