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Sep. 28. 2016 3:32PM <br />Form 668 (Z) <br />(Rov. 10 -20001 <br />Name of Taxpayer <br />MEDBERY FABRICATION LLC <br />Liber <br />n/a <br />Kind of Tax <br />(a) <br />940 <br />941 <br />Place of Filing <br />Page <br />n/a <br />E Secretary of State — UCC <br />14742 Department of the Treasury - Internal Revenue Service 2 016 0 6 4 3 2 <br />Certificate of Release of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED. AREA ff4 <br />Lien. Unit Phone: (sae) 913 - 605D <br />Residence3230 N. NORTH RD <br />GRAND ISLAND, NE 68803 -9726 <br />Tax Period <br />Ending <br />. 0) <br />12/31/2013 <br />12/31/2013 <br />Identifying Number <br />f�) <br />XX- XXX1490 <br />XX- XXX1490 <br />Serial Number <br />COURT RECORDING INFORMATION: <br />UCC.No. Serial No. <br />9915752466 -3 201502392 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />151715115 <br />I certify that the following -named taxpayer, under the requirements of section 6325 (a) <br />of the Internal Revenue Code has satisfied the taxes listed below and all statutory <br />additions. Therefore, the lien provided by Code section 6321 for these taxes. And <br />additions has been released.. The proper officer in the office where the notice of <br />internal revenue tax lien was filed on ' April 17 <br />2015 , is authorized to note the books to show the release of this lien for <br />these taxes and additions. <br />Date of <br />Assessment <br />• (d) • <br />03/03/2014 <br />03/03/2014 <br />****' Iffr 3f********* fr71C 7r ** *7k * * * * ** * ***v * ** * * ** <br />Last D i for <br />Refiing <br />.(e) <br />No, 8178 F. 3/3 <br />For Use by Recording Office <br />On= of Stale John A Colo - UCC <br />1 <br />9916780533 -2 Pss: <br />MEDBERY EDWIN SR SOLE MBR <br />Filed_ 09/29/2016 11:22 RM , <br />Unpaid Balance <br />of Assessment <br />(f) <br />04/02/2024 280.81 <br />04/02/2024 • 6833.84 <br />Total $ 7114.65. <br />This notice was prepared and signed at CHICAGO; IL <br />the <br />Signature <br />14 .day of September:. 2016 <br />eAA-t <br />[BETE <br />Title Director, Specialty Collections <br />(NOTE: Certificate of officer authorized by law to take acknowledgments ie not essential to the validity of Certificate of Release of <br />Federal Tax lien Rev. 71 -466, 1971 - 2 C.9. 409) . <br />Part 1. - RECORDING OFFICE <br />Form 668 (Z) (Rev. 10 - 2000) <br />, on this, <br />,4c5 <br />