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06/].0/2009 1NLD 14:20 FAX 402 471 4429 UCC SECRETARY pF STATR ~~~ Hall <br />X003/004 <br />N~ Sve er S!e!v Jahn R Gsls - OCC T09 <br />,,. 200904539 ~~-;,~::~: <br />Please return row" ~ ' <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />9909'599019-6 Pgs: 1 <br />~ 811 WEST ZNp ST STE 46O MRRTINEZ JRNES R <br />GRAND ISLAND NE 68803 FLIaa: msr~mr2mms tm:m~ RM <br />,~„~ ~,~ State Tax Lien Statement of Termination or <br />~E~~lE Certificate of Partial Release or <br />-w~+wwvwrwwrryrr_+isw.~irw~ <br />Subordination <br />PLEASE DO NOT WRITE IN THIS SPACE <br />Pursuant tla the revenue laws of the State of Nebraska, notice is hereby <br />given that the State lax lien which has been duly filed by the Nebraska <br />Department of Revenue asainst 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 />o~-sss~ ~ ~ ~ 21-504a281 xxx-xx-a~ae <br />Lien Serial Number Llen filed with pate of Lien Tax Category Gounty <br />220080087 QRegister of DeedsCounty Clerk 03/11/200$ . -01 & 21 Hall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name . <br />........:. ... ... ..... .... .. . DAMES A MARTINEZ. <br />Street-{Address .' • • • - - ' - • ' Street or Mailing Address <br />. __- 3"t11 BRENTWOOD CIRCLE <br />GRAND ISLAND NE 68803 <br />-Type of Action . <br />© TERMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. UCC Instrument Number 990$552342 <br />Caurrty Instxumerrt Number 2 <br />TAX YEARS (corporate,lndividual income, and withholding.tax only) 2006 ' <br />Q PARTIAL RELEASE. Tha State Tax Lien is partially released as follows; - UCC instrument Number <br />TAX YEARS (corporate, individual income, and withholding tax only) <br />County Instrument Number <br />SUBORDINATION. The Stake Tax Lien is subordinated as follows. UCC Instrument Number <br />County Instrument Number <br />.:, , .... hereby certifythat the Nebraska Department of Revenue-has, compli~tl' ' . fie. revenue; laws of the State o Nebraska in <br />determination of the termination, partial release, or subordination indicated above. ' ' <br />sign ~ Revenue Senior A e ' ~ f :3 ~. - . ~3o S <br />. .. ~- 385-8073 <br />rle~@ Prepay rs Signatu 'Title Date Telephone N bey <br />Revenue 5u rvisor <br />orize ure Title p <br />4-2328 Rev. 8.96 $upersodes 4232-f~ ReV. 10A5 <br /> <br />