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r <br />Notice of State Tax Lien <br />asks Discharge, Release, or SubordinatiorO, 004857 <br />invent a Read i..r-4inn- nn reverse side <br />Lien Serial Number <br />Release Serial Number <br />Date of Linn <br />Soclal Security Number i <br />4/10/665 <br />8708 <br />10 -16 -84 <br />506 -46 -1639 <br />Nebraska I.D. Number <br />County <br />Filed with <br />Spouses social security <br />�Li]en <br />W Register of Deeds <br />Number <br />3164144 <br />Hall <br />County Clerk <br />BUSINESS NAME AND LOCATION <br />ADDRESS <br />TAXPAYER NAME AND MAILING ADDRESS <br />Business Name <br />T <br />Name - -.- <br />Boltzs Market Inc. <br />Jerome &Janet Boltz _ <br />Street Address <br />Street or Omer Matting Address <br />508 East 6th Street <br />_R R. 3, Box 261A <br />City State <br />Zip Cotle <br />City state Zip Code <br />Grand Island, NE <br />68801 <br />Grand Island. NE 68801 <br />Pursuant to the revenue laws of the State of Nebraska, notice is hereby given that the Notice of State Tax Lien <br />which has been duly filed against the above named taxpayer, is discharged, partially released, or subordinated to the <br />extent indicated below. <br />F— TYPE OF ACTION <br />fi� DISCHARGE TAX LIEN. The Notice of State Tax Lien is hereby fully discharged <br />J PARTIAL RELEASE. The Notice of State Tux Lien is released as follows. <br />0 SUBORDINATED. The Notice of State Tax Lien is subimlina!ed as 1-allows. <br />ebY ilia .h AI the N rdiY) pehAllhleh! r.l {1 evNh tie hai C hiphetl with the --t— ;a wl hf me State .1 riet— Ka hi the :ete,- <br />rn.h)tion edra ) e p)rti I rNINAS 'A 'L 1' dl.On rhni..dletl an�N•' <br />c° -- - Ld_: -• - -- T,t eRev_enue_ Agent -- - - -- - - -- 10`2 -85 l. - - -_- <br />Y • Da <br />Special Agent 10 -2 -85 <br />AYtRa..re4 Sig i t <br />FOR COUNTY OFFICIAL'S USE I <br />NEBRASKA DEPARTMENT CIF REVENUE - Whdti -risf CAnary Cup— TAXPAYCH - P.nk Copy COUNTY OFFICF. - Golilenrnu Capy <br />4�2J2 !sa Rev. 1 -91 <br />U <br />A <br />M <br />J; <br />f <br />�r <br />F' <br />