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��� � U <br /> \ � � �.s --�"-s� <br /> t�'t <br /> ) � �:_ :- � <br /> �' i --9 � � �_� .,, �� <br /> � ;_;_, � . �, � �. <br /> � ' � -�, T � � � <br /> � f� -, '.;....� cn <br /> � � t7 ,�' � _, ' r� x c c� c�n <br /> � � �, � `�� '_`' r � � <br /> � °'� ,� ° M1: �.J � <br /> ��' �� ',� �-- .t��v � � <br /> ,� � �`� � f''� � Z <br /> c�\\ V V'3 �p <br /> ��� <br /> �h � State Tax Lien Statement of Termination <br /> �Ir <br /> or Certificate of Partial Release or <br /> �� � <br /> °'P"°"'� Subordination <br /> a rw�nw <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 tiled by the Nebraska <br /> Department of Revenue against the below-named taxpayer,is termtnated, <br /> partlally released,or subordlnated to t6e extent tndlcated below. <br /> Nebraska Identification Number Tax Category Social Security w Federal I.D.Number Spouse's Social Security Number <br /> 40246280 22 52 _ <br /> Lien Serial Number Lien Filed With Date of Lien Cp�my <br /> 9 8 0 4 4 0 2 4 3 �Register of Deeds ❑co��,cy aen� 2_ <br /> BUSINESS NAME AND LOCATION ADDRESS TAXPAYER NAME AND MAILING ADDRESS <br /> Business Name Name <br /> Street Address Street or Other Mailing Address <br /> �Y State Zip Code CitY State Zip Code <br /> TYPE OF ACTION <br /> [�TERMINATION OF TAX UEN. The State Tax Lien is hereby fully terminated. INSTRUMENT NUMBER <br /> TAX YEARS (corporate, individual income, and withholding tax only) 19 9 6 <br /> ❑PARTIAL RELEASE. The State Tax Lien is partially released as follows. INSTRUMENT NUMBER <br /> TAX YEARS (corporate, individual income, and withholding tax only) <br /> ❑SUBORDINATION. The State Tax Lien is subordinated as follows. INSTRUMENT NUMBER <br /> Name of party making request and responsible Tor filing certificate of partial release or subordination with appropriate filing officer. <br /> I hereby cerUTy that the Nebraska Department of Revenue has complied with the revenue laws of the State of Nebraska in the determination of the <br /> terminaY ,partial release,or subordination indicated above. <br /> sign , • . - 3��-q� c�o8� 385-l�07'{ <br /> here � ��s ��fe � r� <br /> � Telephone No. <br /> � ¢ Signatu e ' T e ���� <br /> Date <br /> NEBRASKA DEPARTMENT OF REVENUE-White and Canary Copies TAXPAYER-Pink Copy COUNTY OFFICE-Goldenrod Copy <br /> 4232-68 Rev.&96 Supersedes 4-232-68 Rev.10-95 <br />