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<br />10/15/2007 MON 15:55 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121010/010 <br /> <br />alQ <br /> <br />Please forward to: <br />Nebraska Dept of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />200708898 <br /> <br />1!lIIlllllll'llU <br /> <br /> <br />9907529681-1 pss : <br />COTE. JOSEPHINE K. <br />Filed: 10/15(2007 03:29 PM <br /> <br />I1r <br /> <br /> <br />State Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />Subordination <br /> <br />n~rulQ <br />do\WIftMOtll <br />ofl'G_ <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 Tax .Category Social Security Number Spouse's Social Security Number <br /> 12459178 22 506-34-3402 507-38-0142 <br />Lien Serial Number Uen filed with Date of Lien County <br /> 061600225 IKl Register of Deeds D County Clerk 06/12/2007 Hall <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Leroy G & Josephine K Cote <br />Slreet Address Street or Mailing Address <br /> . 2206 N Custer Apt C <br />City Slate Zip Code , City State Zip Code <br /> Grand Island NE 68803 <br />r Type of Action I <br />~ TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. UCC Instrument Number (99075131837 ~ <br /> <br />County Instrument Number 200704891 <br /> <br />TAX YEARS (corporate, individual Income, and withholding tax only) 2003 <br /> <br />o PARTIAL RELEASE_ <br /> <br />The State Tax Lien is partially released as follows: <br /> <br />UCC Instrument Number <br />County Instrument Number <br /> <br />TAX YEARS (corporate, Individual income, and withholding tax only) <br /> <br />D 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 her certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in <br />ation of t teim' at!on. partial release, or subordination indicated above. <br /> <br />Revenue Agent <br />Tille ' <br />Revenue Supervisor <br />Title <br /> <br />10/11/2007 <br />Date <br /> <br />308 632-1200 <br />Telephone Number <br /> <br />10/11/2007 <br />Date <br /><4-232-68 Rev. 8-96 Supersedes <4-232-69 Rev. 10-95 <br /> <br />(j <br />