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<br />04/15/2009 WED 12:24 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1iilI005/009 <br /> <br />~ <br /> <br />N& Su Df" Stot. John II Gol. - uee TII9 <br /> <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2ND ST STE 460 <br />GRAND ISLAND NE 68803 <br /> <br />200902825 <br /> <br /> <br />9909593523-9 Pg$: 1 <br />GOODRICH MARK D <br />Fiied, 04/15/2009 09:10 AM <br /> <br />~.~n4,; <br /> <br />'" <br /> <br /> <br />State Tax Lien Statement of Termination <br />or Certificate of Partial Release or <br />Subordination <br /> <br />1l~ <br />........ <br />...0;... <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 Uen 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 /> 9078541 506-08-7986 <br />Lien Serial Number Lien filed with Date of lien Tax Category County <br /> 03/07/0019 IKJ Register of Deeds D County Clerk 04/06/2007 Hall <br />1- BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Mark D Goodrich <br />Street Address Street or Mailing Address <br /> 2831 Wortman Ave, # 7 <br />City Stata 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 C 9907504677-3 ) <br /> <br />!, <br /> <br />r <br /> <br />County Instrument Number 200702922 <br /> <br />TAX YEARS (corporate, Individual income, and withholding tax only) <br /> <br />o PARTIAl RELEASE. <br /> <br />The State Tax Uen is partially released as follows: <br /> <br />UCC 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 />UCC Instrument Number <br />County Instrument Number <br /> <br />;' <br />i <br /> <br />I hereby certify lhatlhe Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in <br />determination of the t ina ion. partial release, or subordination indicated above. <br /> <br />sign .. <br />here <br />... <br /> <br /> <br />Revenue Senior Agent <br />Tille <br />Revenue Supervisor <br />Title <br /> <br />J./j )3 1A-/Jf} J <br />Date I <br /> <br />308 385-6073 <br /> <br />'F;;~' <br /> <br />4.232-68 Rev. 8-96 Supersedes 4-232.{j9 Rev. l~h 0 <br /> <br />\, \}> <br />