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the <br />Sep.28. 2016 3,32PM NE Secretary of State — UCC <br />Form 668 (Z) <br />(Rev 10 -20001 <br />14742 Department of the Treasury Internal Revenue Service <br />Certificate of Release of. Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 - 6050 <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 October 29 <br />2014 , is authorized to note the book; to show the release bf this lien for <br />these taxes and additions. <br />Name of Taxpayer <br />MEDBERY FABRICATION LLC <br />EDWIN MEDBERY SR SOLE MBR <br />Residence 3230 N NORTH RD <br />GRAND ISLAND, NE 68803 -9726 <br />Serial Number <br />COURT RECORDING INFORMATION: <br />Liber Page. UCC No. Serial No. <br />rt /a n/a ' 9914744013 -2 201406876 <br />Tax Period Date of <br />Kind of Tax Ending ' identifying Number Assessment <br />( al ( bJ (c) (d) <br />940 12/31/2013 XX- XXX14 03/03/2014 <br />941 12/31/2013 XX-XXX1490 03/03/2014 <br />************** * * *** * * * * * * * ** * * * * * .Y * * * ** * * * ** <br />Place of Filing <br />This notice was prepared and signed at <br />Signature <br />14th d ayo <br />,Register of..Deeds. <br />Hall POBOX 1692 <br />Grand. Island, NE 68802 -1692 <br />September 2016 <br />124974014 <br />NE Soe of State John A Gale - UCC CRFTL <br />I � <br />I <br />n llit <br />Pea: 1 <br />9918780b2 — 0 <br />MEDBERY EDWIN SR SOLE MBR <br />Filed: 09/2B12016 11:22 RM. <br />For Use by Recording Office <br />Last Day for <br />ReIi ng <br />(e) <br />04/02/2024 <br />04/02/2024 <br />* * * * * * * * * * ** <br />Total <br />No. 8178 P. <br />201606433 <br />Unpaid Balance <br />of Assessment <br />(f) <br />280.81 <br />6833.84 <br />**** * * * * * ** * * * ** <br />$ 7114.65 <br />• CHICAGO, • IL. , o.n this, <br />Title Director, Specialty Collections <br />(NOTE: Certificate of officer authorized by raw to take acknowledgments is not essential to the validity of Certificate of Release of <br />Federal Tax Tien Rev. RUI. 71 -466, 1971 2 C.B. 409) r <br />Part 1 - RECORDING OFFICE Form 668 (Z) (Rev. 10 -2000) G <br />CAT. NO 600261 <br />