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03/10/2011 THU 14:00 FAX 402 471 4429 UCC SSCRBTARY OF STATE ��� Hall <br />l �l <br />�0071007 <br />...,� �, <br />201101944 <br />STATE TAX LIEN o NEBRASKA DEPARTMENT OF LABOR ��L Oftice of Legal Counset <br />P.O. Box 94600 <br />Lincoln, NE 68509-4600 <br />� TE1tMIlVATIOIV Telephone - (402) 471-9912 <br />FAX - (402) 471-9917 <br />Employer or <br />I,iable Person: Eugene Kosmicki <br />Address: 1307 West Division Street, Grand Island NE 68801 <br />NDOL Acct. No.: 030243500'7 <br />Federai ID No. J SSA No.: <br />This T�RMINATION serves to remove the lien described below and the priority of the Nebraska Department of Labor on the <br />affected property of this employer or person. This Termination is filed pursuant to Neb. Rev. Stat. §§48-657, 48-660.01, 48-664, <br />and the Uniform State Tax Lien Registration & Enforcement Act (Neb. Rev. Stat. §77-3901, et seg,). <br />LIEN TO BE TERMINATED: <br />Y I FULL Termination PARTIAL Release <br />Property description (ON�Y if PARTIAL Release): <br />n/a <br />NDOL Serial No. : LAB-0025-2007 <br />State Tax Lien Document No. : 9907492355-6 <br />County: Hall <br />County Document Filing No. : 0807000634 <br />Other Filing Information: Org. filed Co. O1/25/Q7(a�420 <br />#0200700634 <br />I certify that the Nebraska Departarent of Labor has complied with the Employment Security Law of the State of <br />Nebraska in the determination of the amount due, and the employer or person has failed to pay the amount due aker <br />demand. <br />Date: March 10, 20l 1 <br />T:�DOCUMENTS�FORMS\Liens\Termination.docx <br />$y: <br />RETURN FILED COPIES TO: Nebr. Dep� of Labor - LEGAL NEBR DEPT. OF LABOR <br />1�.0. Box 9a600 CHARGE ACCT #14765 <br />Lincolu, NE 68504-4600 <br />CATHERINE D. LANG <br />