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NE Sec of State - Robert B. Evnen <br />Filing Document #: 2104001324-3 Pages: 1 <br />Debtor Name: KINGS BAR & GRILL <br />Filing Date and Time: 04/21/2021 09:47 AM <br />202103238 <br />Form 668 (Z) <br />iRev. t0-20001 <br />17489 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 />Serial Number <br />868756612 <br />For Use by Recording -Office <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 <br />on May 29 <br />2012 <br />, is authorized to note <br />the books to show the release of this lien for <br />these taxes and <br />additions. <br />Name of Taxpayer <br />RONALD F KING <br />KINGS BAR & GRILL <br />Residence 2615 W CHARLES ST <br />GRAND ISLAND, NE 68803-5702 <br />COURT RECORDING INFORMATION: <br />Liber Page UCC No. Serial No. <br />n/a n/a 9912692851-1 201204261 <br />Tax Period <br />Date of <br />Last D for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />identifying Number <br />Assessment <br />Refiring <br />of Assessment <br />(a) <br />(b) <br />(C) <br />(d) <br />(0) <br />(f) .. . _. <br />940 <br />12/31/2011 <br />XX-XXX2920 <br />04/16/2012 <br />05/16/2022 <br />349.80 <br />****************irk#*#****w******* <br />i****************,t*•*****4**************** <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 349.80. - <br />Grand Island, NE 68802-1692 <br />CHICAGO, IL <br />This notice was prepared and signed at , on thiq, <br />the 17th day of March , 2021 <br />Signature <br />Zt- <br />Title <br />Operations Manager, <br />Centralized. Lien Operation <br />(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Release of <br />Federal Tax lien Rev. Rul. 71-466, 1971 - 2 C.B. 4091 Form 668 (Z) {Rev. 10.2000) <br />Part I - RECORDING OFFICE <br />CAT. h10 600261 <br />