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O1/26/201p TUB 15:13 FAX 402 471 4429 UCC SECRETARX OF STAIR ~~~ Hall <br />o`~ <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2''1D ST STE 460 <br />GRAND 1SLAND NE 68803 <br />~ooz/ooz <br />~~~~ <br />CLUB B9, 1N~• <br />Filed: 01/26/2010 02:43 PM <br />2oiooo5s~ <br />,"!,k~'"'~ „ ~ State Tax Lien Statement of Termination or <br />~~E Certificate of Partial. Release or <br />wwrw_rrxsnar.ne.Oq+r <br />Subordination <br />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 Indicated <br />below. <br />Nebraska Identification Number Federal Identifcation Number Social Security Number Spouse's Social Security Number <br />9677003 20365805$ <br />Lien Serial Number Llen filed with Date of Lien Tax Category County <br />- OD309pD04 ORegister of Deeds []County Clerk 06/22J2D09 01 Fi811 <br />BUSINESS NAME ANq LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />Business Name Name <br /> Club 69,Inc. <br />Street Address Street or Mailing Address <br /> 106 E Third St <br />City State Zip Code City State Zip Code <br /> • Grand Island NE 68801 <br /> Type of Action <br />^X TERMINATION OF TAX LIEN. -The State Tax Llen is hereby fully terminated. UCC Instrument Number 9 9600359- <br /> - County Instrument Number 200905097 <br />TAX YEARS (corporate, individual Income, and withholding tax Doty) <br />PARTIAL RELEA&E. Tha State lax Lien is partially released as follows: UCC Instrument Number <br /> County Instrument Number <br />TAX YEARS (corporate, Individual Income, and withholding tax only) <br />SU80RDINATION. The State Tax Lien is subordinated as follows. UCC Instrument Number <br /> • County Instrument Number <br /> <br /> <br /> <br />I here y certify that the Nebras a partment o Revanus as comp i wit the revenue awe o the State o braska m <br />determination of the termination, partial release, or subordination indicated above. C~a~ <br />sign l ~~ Revenue Senior Aye/ 01/21/2010 385-6073 <br />here prep s Si u Title ~ ~~ Dais Telephone Number <br />RevenueSeniorA ent D1/21/201D <br />thou d igna re Title Date <br />• 42326 Rev. 8~6 Supersedes A-23269 Rev.10-85 <br />~- <br />