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1 <br />State Tax Lien f �,�, <br />Statement of Termination or 87-- <br />Certificate of Partial Release or Subordination <br />Lien Serial Number <br />Document Serial <br />Date of Lien <br />a <br />oft �rt�t <br />- - <br />84013084 <br />Number <br />10067 <br />1 <br />State Tax Lien f �,�, <br />Statement of Termination or 87-- <br />Certificate of Partial Release or Subordination <br />Lien Serial Number <br />Document Serial <br />Date of Lien <br />Social Security or <br />Number <br />- - <br />84013084 <br />Number <br />10067 <br />4 <br />Federal 1'.D. Number <br />505 -64 -2326 <br />- <br />Nebraska I.D. Numtfer <br />County ith <br />Spouse's Social Security <br />11859415 <br />Nall <br />f Dews <br />lerk <br />Number <br />BUSI NESS <br />NAME AN - - <br />?J00M, <br />TAXPAYER NAME AND MAILING <br />Business Name <br />- <br />Name <br />q �t�� <br />Ste n $ NanC <br />as y t�� <br />t"Is Milbpurn <br />Street Address <br />_ <br />Street or Oilier. Mainng Aatlress <br />1. <br />City <br />State <br />Zip Code <br />City _ <br />State _ Z� code <br />Brand Island <br />NE 68801 <br />Pursuant to the revenue laws of the State of Nebrad-,a, notice is hereby given that the State Tax Lien which has been duly <br />filed by the Nebraska Departinent of Revenue against the above named taxp.-yer, is terminated, partially rekaspd, or 311111asI& <br />Bated to the extent indicated below. <br />TYPE OF ACTION - - <br />® TERMINATION OF TAX LIEN. The State Tax Lien is hereby fullv terminated. <br />PARTIAL RELEASE. The State Tax Lien is partially released as follows. <br />Name of party making teauesi and responsraie for riling [ertin `ate of partial release wEih appropriate £,Ting offlay. - <br />SUBORDINATION. The State Tax Lien is subordinated as follows_ <br />Name of party making requ ,, and res"nslbte tot filing certificate o1 subordination with appropriate fitinq officer. - <br />-I herebY cerlifY that the Nebraska Department of Revenue nas cOthoiieo Wit" the reser.ue laws of. the state D1 Nebreskka In the <br />alto inetiW: Of the termination, V_tWi r w se or abMOin 77 indicated al-, <br />Rerenue Agent <br />_ 16AI&NO _ :�;c Date <br />_ Special Agent <br />- •.•_ authoriser! TAN, Date <br />FOR COUNTY OFFICtAI: S USE <br />It L <br />NEBRASKA DEPARTMENT OF REVFNIIF _ wt,:.a �.... r_____ - _ <br />-_ — r vas IstXrr.Terr — pteaic CuVr COUNTY OFFICE — Goldenrod Copy <br />- - - _ <br />4- 232-68 Rer. 5-86 r <br />Supersedes 4232.68 Ree. t -81 <br />a <br />f <br />ti. <br />