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03/08/2010 MqN 14:53 FAX 402 471 4429 UCC SECRETARY pF STATE yy-~ Hall <br /> <br />Please return to: <br />STATE OF NEBRASKA <br />DEPARTMENT OF REVENUE <br />1811 WEST 2NA ST STE 460 <br />GRAND ISLAND NE 68803 <br />201001515 <br />~~~~ <br />RYebrrbke D1Ap~1YiMs~tlmt' kir <br />~~~~ <br />wkrvM+r.K rrvrnur.rkr<.q~ <br />iaj004/011 <br />NE Sao of Sk~kv John A G~lv -UCC T09 <br />9910621710-4 Pss: 1 <br />KLINGINSMITH 0[:NNETA M <br />Fllsd: 03/09/2010 08:42 AM <br />State Tax Lien Statement of Termination or <br />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 has 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 />Nebraska Identification Number Federal Identification Number Sncial Security Number Spouse's Sncial Security Number <br />9141480 508-12-0722 <br />Lien Serial Number Lien filed with Date of Lien Tax Category County <br />05/11/347 QRegister of Deeds []County Clem .11103/2005 01 21 HALL <br />BUSINESS NAME A ND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRES5 <br />Business Name Name <br /> Denneta M Klinginsmith <br />Str®et Address Street or Mailing Address <br /> 1621 Hagge <br />City State zip Code City State Zip Code <br /> Grand Island NE 68801 <br /> Type of Action <br />QX TERMINATION QF TAX LIEN. the State Tax Lien is her®by fully terminated. UCC Instrument Number 9905421072-7 <br />County Instrument Number 20051 1 1 04 <br />TAX YEARS (corporate, Individual income, and withholding tax only) 2004/2005 <br />PARTIAL RELEASE. The State Tax Lien is partially released as follows: UCC Instrument Number <br />County Instrument Number <br />TAX YEAR5 (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 />I ere y certify that the Nebraska Department o Revenue has comp i wit t e revenue laws of the State of Nebraska in <br />determination of the termination, partial release, or subordination indicated above. <br />S~9n Revenue Senior A e `3 Sl 308 3$5-6073 <br />here Preparer's Sign re Title Date Tele~ho~ Number <br />Revenue Senior ent <br />Authorized ignatu Title Data <br />4,2328 Rev. 8-96 Supersedes 4-2d2~9 Rev. 10-95 <br /> <br />