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08/19/2009 GPBD 15:07 1?AX 402 471 4429 ^CC SECRETARY OF STATE yyy Hall <br />~~:*.. ,. ~~c~ <br />„r <br />'PS''~ .... .. '+-'. 4?r.r~c <br />Please forward to: <br />Nebraska Department of Revenue <br />4500 Ave 1 PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br />~ =.i.:.L'~. <br />2oososss3 <br />f~ooz/nOs <br />~ Swc pf 4!e!i JPhn A Oale -UCC T09 <br />9909605038-5 Pgs: 1 <br />MCGORMICK DONHI.D W III <br />Filed: 08/19!2009 10:02 AM <br />>rw~ ,sk,~~,,,,m,M~r State Tax Lien Statement of Termination or <br />~~~~~E Certificate of Partial Release or <br />www.rrv~n~u~.~nr.tr av <br />Subordination <br />DO NOT WRITE IN TMIS 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, ar subordinated to the extent tndlcated <br />below. <br />Nebraska Identification Number Federal IdenC~ication Number Social Security Number Spouse's Social Security Number <br />41996771 XXX-XX-9452 XXX-XX-8379 <br />Lien Serial Number Lien filed with Date of Lien Tax Category Ccunty <br />30450363 Register of Deeds ]County Clerk 09/10!2004 22 Hall <br />BUSINESS NAME A ND LOCATIQN ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Donald W & Jessica ICay McCormick III <br />Street Address Street or Mailing Address <br /> 107 S Oak St Apt 3 <br />Gity State Zip Code City State Zip Code <br /> Grand Island NE 88801 <br /> Type of Action <br />© TERMINATION OF TAX LIEN. The State lax Lien is hereby fully terminated. UCC Instrument Number 9 5750 <br />County Instrument Number 20 <br />TAX YEARS (corporate, individual income, and withholding tax only) 2001 <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 />SUBdRDINATiON. The State Tax Lien is subordinated as follows. UCG Instrument Number <br />County Instrument Number <br />1 he y certify that the ebraska Department avenue has complied with the revenue laws o t e fate o Ne raska in <br />date anon a t ination, pa ' I release, or subordination indicated above. <br />sign Revenue A, en9 t -- 08/13/2009 308 632-120p <br />here re er• 'oat Title Date Telephone Number <br />Revenue 5upervisor_ _ , . 08/13/2009 <br />Au horized 'nature Title Date <br />a-xiz~ae Rw. a-es s~~s a.sas~s rs~,. ~a9s <br />.. ~" <br />