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07/16/2010 FRI 15:26 FAX 402 471 4429 UCC SECRETARY OF STATE ~yy Hdll <br /> <br />201004952 <br />~p02/002 <br />Sac o[ Siai• John A de19 <br />T99 <br /> <br />_ __~__ ___ ..~_ -... Ff.tad; 07/16ri:n1~0 in:~~ <br />Nebraska Department of Revenue <br />4500 Ave I PO Box 1500 _ <br />Scottsbluff, NE b9363-1500 <br />~fi r„k,~,~*,.,~,,,;,,~~, State Tax Lien Statement of Termination or <br />~E~V~E Certificate of Partial Release or <br />www.r~wvrwr.r, nw.4~v <br />~_ Subordination <br />PLEASE DO NOT WRITE IN THIS 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 />4epartrnent 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 IdentiCcation Numher Social Security Number Spouse's Social Security Number <br />43165699 XXX-XX-0375 <br />Lien Serial Number Date of Lien Tax Category County <br />72010295 , Lien filed with Register of Deeds 09!30/2008 HALL <br />BUSINESS NAME ANp LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br />cHAV~z r3oLANOSrosMIN <br />450519TH ST APT C1 <br />COLUMBUS NE 68601 <br />Type of Action <br />® TERMINATION OF TAX LIEN. The State Tax lien is hereby fully terminated. UCG Instrument mbar 99085716827 <br />TAX YEARS 2004 County Instrument Number p 5 <br />(corporate, individual income, and wlthholding tax only) Continuance: UCC instrument Number <br />Continuance: County Instrument Number <br />PARTIAL RtrLEASE. The State Tax lien is partially released as follows: UGC Instrument Number <br />TAX YEARS County Instrument Number <br />(corporate, individual income, and withholding talc only) <br />SU90RDINATION. The State lax lien is subordinated as follows. UCC instrument Numher <br /> County Instrument Number <br />r ~~~ ~~~ ~.~U~d tie ueFwrunern o~ rcevenue nos compuea vn[n me revenue Taws or the State of Nebraska m <br />dale not' th rminalion, artist release, or subordination indicated above. <br />Slgn Revenue Agent ~ ~ U 308632-1200 <br />~_...- <br />here Pep nal r Title ~~~~ to Telephone Number ~~- <br />Authorized lure Title Date <br />4_492-ea Rev. 8.88 Supersedes 4.73Y~8 Rev.10-95 <br />