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10/18 /2001 16:28 FAX 14024714429 NEBRASKA UCC <br />59599 Tre a t a <br />Form 666 (Z) Ce a <br />(Rev. 10.2000) <br />Area: aria <br />SMALL BUSINESS/SELF EMPLOYED AREA #9 390037231 <br />Lien Unit Phone: (414) 297 -3211 <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 August 28 <br />2000 , is authorized to note the books-to show the release of this lien for <br />these taxes and additions. <br />Name of Taxpayer <br />KEITH A JORGENSEN <br />Residence821 W OKLAHOMA <br />GRAND ISLAND, NE 68801 -6754. <br />Li`ber Page <br />2000 0699 <br />Kind of Tax <br />(a) <br />941 C <br />941 <br />941 <br />541 <br />941 <br />941 <br />Place of Filing <br />Register of Deeds <br />Hall POSOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice notice was prepared and signed at <br />the 15th day of October 2001 <br />Signature <br />MILWAUKEE, WI <br />Z002/002 <br />Till <br />I <br />POs: t <br />a3: 46 PM <br />200110647 <br />Unpaid Balance <br />of Assessment <br />(V <br />4739.15 <br />328.06 <br />2433.56 <br />7361.25 <br />7578.89 <br />7234.88 <br />, on this, <br />Title Compliance Technical Support <br />Manager <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. 409) Form 668 (2) IRev. 1420001 <br />Part 1 . RECORDING OFFICE CAT. NO 600261 <br />