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Notice of State Tax Lien <br />nebraska Discharge, Release, or Subordination <br />deparemertt • Read instructions on reverse side <br />of revenue <br />(Jan Serial Number Release Serial Number Date of Llen Sotlal Seturlty Numbar ^~ <br />'F r, ('1 ~s,^~.,~~ V <br />( ~ <br />} <br />9/11/811 3469 11-14-79 508-70-9583 _^ <br />V <br />Nebraska f. D. Numbs County lien Filetl Wlth Spouse's Social Seturlty <br /> Register pt D eeos Numb?! <br />3354458 Nall p cDUnty clerk 1 _ i <br />BUSINESS NAME AND LOCATION ADDRESS TAXPAVER NRME AND MAILING ADDRESS <br />Business Name Na me <br />Derby Retail I Becky Autry <br /> <br />Street Atltlless <br />Street or Otner - <br />Mailing Atltlress <br />1135 South Locust ~ P.O. B ox 525 <br />City State Zia Cotle City state Zia Cotle <br />Grand Island, Ne. 68$01 I Siloam Sorinas. Ark. 7?761 <br />Pursuant to the revenue laws of the State of Nebraska, notice is hereby given that the Notice of State Tax Lien <br />which has been duly Cried against the move named taxpayer, is discharged, partially released, of suberdina[ed to the <br />extent indicated below. <br />TV PE OF ACTION l <br />)~ DISCHARGE TAX LIEN. The Notice of State Tax Lien is hzrzby fully dischareed. <br />L PARTIAL RELEASE. The Notice of State Tax Lten is released as follows. <br />~! SL',BORDINATED. The Notice of State Tax Lien is subordinated as I Dilutes. <br />I hereby tertity tnat the Nebraska Department of geuenue n35 tomFheb w~nn the revert ~e IaslK ~* ..•e S:a to .~I Nebraska ;n .re .te[e~~ <br />sign urination at th narge, partial elease or 5 ~i ~ti :r.tlicateo aD <br />here. ~' 5~ecial Anent __--- fii2~Z-- <br />AuIhorlmd Stgnaty ~ Otte Date <br />FOR COUNTY OFFICIAL <br />NEBRASKA DEPAATAIENT OF REVENUE - t'Yhrte and Cana=y Cap+es TAXPAVER P,nk Cony COUNTY OE~tCE - Gu:denroo Copy <br />4232-5Z Rev- 5~]H <br />Suaerseces C-232-58 0.ev. 5-74 <br /> <br />U <br /> <br /> <br />