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05/07/2010 FRY 15:33 FAR 402 471 4429 UCC SECRETARY OF STATL y~+-+ Hall <br />~~' <br />Please Return To: <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 <br />Scottsbluff, NE 69363-1500 <br />2oioo31~0 <br />4~hreskY 3?rpd:rLi-ent q? <br />~~~ <br />I~002/004 <br />NE Soc of S!a!v Jwnn A Gila - l1CC 'r~9 <br />9910826675-3 Pgs: 1 <br />KLINGINSMITH DENNETR r1 <br />Filed: 05/07r20i0 10:31 RM <br />State Tax Lien Statement of Termination or <br />Certificate of Partial Release or <br />Subordination <br />NOT WRITS IN THIS <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 Social Security Number Spouse's Social Security Number <br />42356962 XKX-XX-0722 <br />Lien Serial Number Lien filed with Date of Lien Tax Category County <br />72920284 ^K Register of Deeds County Clerk 06/20/2009 22 Hall <br />BUSINESS NAME A ND LOCATION ADDRESS TAXPAYER NAME AND MAIt_ING ADDRESS <br />.business Name Name <br /> Denneta M Klingensmith <br />Street Address Street or Mailing Address <br /> 1621 West Hagge Road <br />City State Zip Code Clty State Zip Code <br /> Grand Island NE 68801 <br /> Type of Action <br />Q T!^RMINATION OF TAX LIEN. The State Tax Lien is hereby fully terminated. UCC Instrument Number 9085635926 ~ <br /> County Instrument Number 00$05344 <br />TAX YEARS (corporate, individual income, and withholding tax only) 2DD4 <br />PARTIAL RELEASE. The State Taz Lien is partially released as follows: UGC Instrument Number <br /> County Instrument Number <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 />i nerepy mry Inal Ine rve~ a uepar[menl 01 rcevenue nos compose with the revenue laws of the State of Nebraska in <br />determine of the t rmineti a i I release, or subordination indicated above. <br />- <br />Sign Revenue Agent 05/05/2010 308 632-1200 <br />here P ~ natur Title ~ ~ Date Telephone Number <br />Revenue Supervisor 05/05/2010 <br />Authorized Signature Title ~ ~ ~ ~- Date <br />4-23268 Rev. 8-96 Supersedes 4-2329 Rev. 1D-95 <br />