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State Tax Lien $1 16-6107 Statement of Termination or Cartiflest& of Partlal Malanam wr Cutinr�liw�fiw., Wen Serial Number DoCUmehl Serial - -- Dale of lean Social Security Nun, bar 0, Number Federal I'D. Number ALWV,9_ 10804 6 -6 -84 Nebraska I,D. NPmPer County _ ten Filed With - Spoil sa'I Social Security Register of Oeegs Numoer 3869601 Nall County cjerk SUSINBtif NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILINIi AppREiti Business Name Name. C C Industries, Inc. Street Address - _ _ - street or Other Malling Address - -- _ - - - - - - 4196 Arizona CItY State TIP Code City state _ -ZIP Code Grand Island, NE 68801 NE SAR01 Pursuant to the revenue laws of the State of Nebraska, notice is hereby given that the State Tnx lien which has been duly filed by the Nebraska Department of Revenue against the above named taxpayer, is terminated, partially released, or subordi, hated to the extent indicated below. TYPE OF ACTION a TERMINATION OF TAX LIEN, The State'rax Lien is hereby fully terminated. ❑ PARTIAL RELEASE. The State'rax Licit is partially released as fellows. Name of Party making request and responsible for filing certificate of partial release with appropriate filing officer. ❑ SUBORDINATION. The State Tax Lien is subordinated as follows. Name of party making request and responsible for filing certificate of subordination with appropriate filing officer, I hereby certify that the Nebraska Department of Revenue has Compiled with the revenue laws of the State of Nebraska In the - Warm lnation of the termination; fkarllal release or subordination Indicated above. _ Revenue Agent 10 -16 -87 here: 519 re Title Date Special Agent 10 -16 -87 utborized Slgn ure Title Ohio FOR COUNTY OFFICIAL' S USE NEBRASKA DEPARTMENT OF REVENUE - White and Canary Copies TAXPAYER - Pink Copy COUNTY OFFICE - Goldenrod Copy ' 4- 232 -66 Rev. 5- 86 Supersedes 4- 232.66 Rev. 4.81 L � L� U J a