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<br /> � State Tax Lien Statement of Termination �� " �`
<br /> �� or Certificate of Partial Release or , . -.:f��.���L�.
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<br /> � PLEASE DONOT WRITE IN THIS SPACE (-' „l'r�L....��
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<br /> " Pursuant to the revenue luws of the State of Nebrusku,notice ts hereby �. :
<br /> . �iven that the SteteTax Lten which has been duly Uled by the Nebrusku • .�`L�
<br /> � DepartmentofRevenuea�ainstthebelow-namedtaxpuyer,(sterminuted,
<br /> ; � pai�tlally released,or subordfnuted tn thc extent indicAted below. -�-s-
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<br /> , , Nebreake Went�hcatan Nunber Tax Category Soc�al Ser,unty or FeGeral I 0 Number Spouse's Soc�al Secunty Number
<br /> . L�enSenalNumber LienF�ieOWnh OateolUen �+�h .�,e•
<br /> ` 9524400�12 C�}jRegisterotoeeds ❑CountyA�er�c 9-1-95 Hall
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<br /> '� ' BUSINHSS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILINd ADDRESS •�
<br /> � � L'usmess Name Name �- ' �
<br /> � Todd M & Toni L Justiae '�'� . ;
<br /> � Street Atldress Straeta Other MaWng Address f � �
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<br /> - 21I00 Eao�.c�an F8 —� --
<br /> Gry State T�p Code C�ry State Lp Code f ,���•�
<br /> Glenwoo3 IA 51534 '�'�
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<br /> 1YPH OF ACTION +'
<br /> (�TEflMINATION OF TAX LIEN. Thc Staic Tax Licn is hcrchy fully icrminatcd.INS1'RUMENT NUMBER 95-107375 Y,
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<br /> �� � TAX YEAHS(corporats,fndividual income,and withholding tax only) 1994 •;
<br /> � ❑PARTIAL RELEASE. Tlic Staic Tax I.icn is partia�ly rcicascd as f�llc�ws.INSTRUMENT NUMBER � _
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<br /> {�' TAX YEARS(corporete,individual incomo,and withholdtng tax only) __ -
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<br /> ❑�UBORDINATION. Thc S�atc Tox Licn is sutxxdinaled as follows.INSTRUMENT NUMBER ��i_
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<br /> Neme ol parry makmg request anG responsde for Lhng cerhficate ot parnal release or suDordwietion wdh appropnate fihng offMec �`r="�-"' . _
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<br /> ereby cemly tnal the Nobr a Department af Revenue has canpUedwqh tna revenuo laws ot Me State of Nebraske m tne determmatron of Ihe � �'.��r �•• =-�,�'�
<br /> t rtuna .p �al release,or su rtli tion indicated abOVe tiyh��"'� ••.
<br /> sign � Revenue Agent � ( ',����3 , '`° .; �: :.
<br /> here P�ar S,9 �°�e T��e a�+ Telep+h�oneNO. �,;,,
<br /> g� ,�lb Revenue Senior Agent o`� � •:r..�
<br /> Authonle0 Signature TRI6 Dato
<br /> NEBRASKA DEPARTMENT OF REVENUE-Whde and Canary Coples TAXPAYER•Pink Copy COUNTY OFFICE-Goldonrad Copy
<br /> 42J2•68 Rov 698 Superce0ef 4232�68 Rev t0�95 �
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