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12/10/2p09 THU 8:12 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hal]. <br /> <br />Please forward to: 2 ~~ 0 9 Q 9~ 7 5 <br />Nebraska Department of Revenue <br />4500 Ave I PQ Box 1500 <br />Scottsbluff, NE 69363-1500 <br />1002/007 <br />NB See of Sla4e Jehn q Gala <br />' ~~ T09 <br />9909613586-7 <br />ORELLflNA CARLOS P95 1 <br />Filed: 12/08/2009 11:06 AM <br />'~"~; ~~~ ~ State Tax Lien Statement of Termination or <br />l~E'E~1E Certificate of Partial Release or <br />Subordination <br />Pursuant to the revenue laws of the State of Nebraska, notice is hereby <br />given that the State Tax Lien which hae~ 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 />PLEASE DO NOT WRITE IN TIi1S SPACE <br />Nebraska Identihcatian Number Federal Identification Number Social Seeuriry Number Spouse's Social Security Number <br />99221004 XXX-XX-6896 <br />Lien Serial Number Lien filed with Date of Lien Tax Category County <br />52800090 ~]X Register of Deeds [~Gounty Clerk 06/12/2006 22 Wall <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />business Name. Name <br /> Carlos ~rellana <br />Street Address Street or Mailing Address <br /> 304 South Vine Street <br />City State Zip Code City State Zip Code <br /> Grand Island N~ 68801 <br /> Type of Action <br />® TERMINATION OF TAX LIEN. The State lax Lien is hereby fully terminated. UCC Instrument Number 9064526300 <br />County Instrument Number 2046041 <br />TAX YEARS (corporate, Individual income, and withholding tax only) 2002 <br />PARTIAL RELEASE. The State Tax Lien is partially released as follows: UCC Instrument Number ~ <br />County Instrument trfumbo~ <br />TAX YEARS (corporate, individual income, and withholding tax only) <br />SUBORDINATION- The State Tax Lien is subordinated as follows. UCC Instrument Number - <br />County Instrument Number <br />1 he certify that the bras a Department o avenue has complied with t e revenue laws of the State of a ras a in <br />detB ation of the to n ion, rtial release, or subordination indicated above. <br />stgrl Revenue /gent 12/02/2009 308 632-1200 <br />here re Si atu Title - Date Telephone Number <br />- - ~ Revenu_e Supervisor 12/02/2009 <br />A orized ure Title ~ '~ - Date <br />4.237.68 Rev, 8.98 Supersedes 4-2329 Rav. 10,95 ~ / <br />V <br />