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<br />04/15/2009 WED 12:24 FAX 402 471 4429 UCC SECRE~ARY OF S~A~E ~~~ Hall <br /> <br />~004/009 <br /> <br />of() <br /> <br />Please return to; <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />] 811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />200902824 <br /> <br />"""" <br /> <br /> <br />Py<JDRICH "'ARK 0 Pes: 1 <br />ed: 04/15/2009 09, 10 AI'! <br /> <br />.'~,11~P . <br /> <br />~ <br /> <br />State Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />Subordination <br /> <br />.~ <br />~ <br />(/I fMIIUt <br /> <br /> PLEASE DO NOT WRITE IN THIS SPACE <br />Pursuant to the revenue laws of the State of Nebraska, notice Is hereby <br />given that the State Tax Lien which has been duly filed by the Nebraska <br />Department of Revenue against the below-named taxpayer, is <br />terminated, partially released, or subordinated to the extent Indicated <br />below. <br />Nebraska Identification Number Federal Identification Number Social Security Number Spouse's Social Security Number <br /> 9501223 506-08~ 7986 <br />lien Serial Number Lien filed with Date of Lien Tax Category County <br /> 03107/0023 ~ Register of Deeds 0 County Clerk 04/12/2007 01 Hall <br />I BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />.Business Name Name <br /> Mark 0 Goodrich <br />Street Address Street or Mailing Address <br /> 2831 Worbnan Ave, # 7 <br />City State Zip Code City State Zip Code <br /> Grand Island NE 68803 <br />I Type of Action I <br />[!] TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. UCC Instrument Number ( 9907505993-4) <br /> Coun Instrument Number 200703176 <br /> <br />j" <br /> <br />~ . <br />! <br /> <br />o PARTIAL RElEASE. <br /> <br />TAX YEARS (corporate, Individual Income, and withholding tax only) <br /> <br />ty <br /> <br />The State Tax Lien is partially released as follows: <br /> <br />uce Instrument Number <br />County Instrument Number <br /> <br />TAX YEARS (corporate, Individual Income. and withholding tax only) <br /> <br />D SUBORDINATION. <br /> <br />The State Tax Lien is subordinated as follows. <br /> <br />uec Instrument Number <br />County Instrument Number <br /> <br />I hereby certify that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in <br />determination f the termination. partial release, or subordination indicated above. <br /> <br />sign ... <br />here <br />.. <br /> <br /> <br />Revenue Senior Aqent <br />Title <br />Revenue Supervisor <br />. Title <br /> <br />~ 3 }:JJJ/) 9 <br />Date ' <br /> <br />308 385-6073 <br />Telephone Number <br /> <br /><=,"~-~2~~-09 <br />