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07/31/2009 FRI 15:19 kvAX 402 471 4429 UCC 58CRETARY 08 STAT)~ ~~~ Hdll <br /> <br /> <br />. ~ . .. NF See. o1 <br />1002/002 <br />- ucc rse <br />Please forward to: 2 0 0 9 0 6 3 7 4 I~~~,~IIIII~~~~~I~~I~~~~,~~~~~~~~~`~~~~~~~~~~~~~~~ <br />Nebraska De artment of Revenue <br />P 9909603899-~ P95~ 1 <br />4500 Ave Y PO BQ7C 1500 DERBY TERRY <br />SCOttSbluff, NE 69363-1500 Filed: ©7131!2009 12:87 PM <br />ravauraskraeywniwtisMrK State Tax Lien Statement of Termination or <br />~E~E Certificate of Partial Release or <br />YYww.rrv~ nur.rn,iy.YSv <br />Subordination <br />DO <br />Pursuant to the revenue laws of the State of Nebraska, na#ice is hereby <br />given that the State Tax Lien which has been duly flied 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 Identificafion Number Federal Identification Number Social Security Number Spouse's Social Security Number <br />38344513 XXX-XX-0190 <br />Lien Serial Number Linn ,filed with Date at Llen Tax Category County <br />62090155 Register of Deeds []County Clerk 04/15/2009 22 Hall <br />BUSINESS NAME A ND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Terry Derby <br />Street Address Street or Mailing Addrrlss <br /> 518 E Capital 38 <br />City State Zlp Code City State Zip Code <br /> Grand Island NE 68803 <br /> Type of Action <br />© TERMINATION DF TAX LIEN. The State lax Lien is hereby fully terminated. UCC Instrument Number 99095934998 <br />County Instrument Number 2009 <br />TAX YEAR$ (corpnrate, individual income, and withholding tax only) 2D05 <br />PARTIAL RELEASE. The State Tax Lien is partially released,as follows: UCC Instrument Number <br />County Instrument Number <br />TAX YEARS (corporate, individual Income, and withholding tax only) <br />SUBORDINATION. The State lax Lien is subordinated as follows. UCC Instrument Number <br />County Instrument Number <br />I her certr that t e ebras a Department of avenue has complied with the revenue laws o the fate o braska rn <br />date on of th fermi a ' n, partial release, or subordination indipted above. <br />Sign Revenue ggent 07/29/2009 308 632-1200 <br />here r gnat Title~~~ Date Telephone Number <br />Revenue Supervisor _ D7/29/2009 <br />Au orized Si ature Title ~^ Date <br />4 2328 Rav. 8-9d Superaedas 4~92~9 Rev. 10-05 <br />,. ;~ „.. <br />