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<br />02/26/2009 THU 13:58 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1210021002 <br /> <br />JJl <br />V <br /> <br />IIllllllflllllflll <br /> <br /> <br /> <br />ORTIZ LUIS M Pgs: 1 <br />Filed: 02/26/2009 09:09 AM <br /> <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br /> <br />200901447 <br /> <br /> <br />..~ <br />Nebraska DepiI!Irtment of <br /> <br />Notice of State Tax Lien <br /> <br />REVENUE <br /> <br />PLEASE DO NOT WRITE IN THIS SPACE <br /> <br />. ~ -. ~ ___-;:............., ,- "~..I <br /> <br />TERMINATION OF STATE TAX LIEN <br />INDIVIDUAL INCOME TAX <br /> <br />IF YOU INQUIRE ABOUT YOUR <br />ACCOUNT, REFER TO THESE NUMBERS:. <br /> <br />soc. SEC. NO. <br />NEBR. IDENT. NO. <br />SPOUSE soc. SEC. NO. <br />TAXABLE YEAR 2004 <br />LIEN NO. 080320195 <br />LIEN RELEASE NO. 090362292 <br />COUNTY HALL <br />DATE OF NOTICE ~2 03/~-. <br />INSTRUMENT NO. UC ---:....:o~~:_.!_.f!2-~ <br />INSTRUMENT NO. C Y . c:f.OCt:.O"'~f..' <br /> <br />XXXXX7309 <br />37859773 <br /> <br />LUIS M ORTIZ <br />815 W 2ND ST <br />GRAND ISLAND NE 68801 <br /> <br />PURSUANT TO THE REVENUE LAWS OF THE STATE OF NEBRASKA, NOTICE IS <br />HEREBY GIVEN BY THE NEBRASKA DEPARTMENT OF REVENUE THAT THE <br />STATE TAX LIEN WHICH HAS BEEN DULY FILED AGAINST THE ABOVE NAMED <br />TAXPAYER FOR INDIVIDUAL INCOME TAXES IS TERMINATED. <br /> <br />I HEREBY CERTIFY THAT THE NEBRASKA DEPARTMENT OF REVENUE HAS COMPLIED <br />WITH THE REVENUE LAWS OF THE STATE OF NEBRASKA IN THE DETERMINATION OF <br />THIS TERMINATION. <br /> <br />.f1\~_~. <br />PREPARER'S SIGNATURE <br /> <br />.. .uf~illJM.. <br /> <br />AUTHORIZED SIGNATURE <br /> <br />~.~: ~'"-' <br />. . . . -;. . -.:J . . . . . . . . <br /> <br />TITLE <br /> <br />. ~~ Auuo,,/J/)d <br />TITLE' ~ tf <br /> <br />. d[';>'jJ{J.' - . . . - . <br />DATE <br />.. ~ 1a~.!q.~CC. . <br />DATE <br /> <br />PLEASE RETAIN THIS NOTICE WITH YOUR PERMANENT RECORDS. <br /> <br />v <br /> <br />/lT1S 11108 <br />