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a State Tax Lien Statement of Termination or Mz= w - rtITlCwe OT Partial Release Or w ooremnatlon Lion sertai Number Document serial Date of Lien - Social Security Number or -- Number Fed al �3 87 10462 $ -08 -83 50- -L13! Nebraska 1.0. Number County sn F91ed with Spouse's Social Security pf Deeds Number 2 , Hal Hal I .County Clark PILISINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS Susistls Nwe Name 5insel 'Erection Street Address Street or OtiTer Mailing Address 1211 West 4th Street 1 11 &At 4th Street City State ZIP Code City State ZIP Code Grand Island, NE 68801 Grand Island 4E 68801 Purnisat to the revenue laws of the State of Nebraska, notice is hereby Rivers that the State Tax Lion which has been duly filed by the Nebraska Department of Revenue apinst the above named taxpayer, is terminated, partially released, or subordi- ated to the extent indicated below. TYPE OF ACTION © TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. ❑ PARTIAL RELEASE. The State Tax Lien is partially released as follows. " Name of party making reCuest and responsible for filing certificate of partial release with appropriate filing officer. ❑ SUSORDINATION. The State Tax Lien is subordinated as follows. Nam* of party making reauest and responsible for filing certificate of subordination with appropriate filing officer. I herby Certify that the Nebraska Department of Revenue has Complied with the revenue laws of the State of Nebraska in the datarminatiOn of the term {rHtion, partial release or subordination Indicated above. a° e 3 �- _Special Agent 8 -18 -87 Preparers. re Title _ Date Special Agent --- 8- .18 -87 'Auino t:"-si ure _ Title Data - FOR COUNTY OFFICIAL'S USE DEPARTMENT OF REVENUE - White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy 4. 232 -68 Rev. 5.86 Supersedes 4.232.68 Rev. 1.81