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05/19/2004 17:10 FAX 14024714429 NEBRASKA UCC <br />a� -7 <br />€J+ <br />Form 668 (Z) <br />(Rev. 10 -2000) <br />W I :; <br />Department of the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />10004/005 <br />Area: <br />Serial Number <br />For Use by Recording Office <br />WAGE & INVESTMENT AREA #5 <br />Lien Unit Phone: (651) 312 -8080 <br />390368386 <br />NE s.a .t sk. #h. - ucc Tee <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 03 <br />9904334544 -0 Pips: 1 <br />__ <br />2003 , is authorized to note the books to show the release of this lien for <br />Filed:E 5/199 L <br />Filed: 05/19/2004 01;43 PM <br />these taxes and additions. <br />Name of Taxpayer <br />JAMES L MOHNIKE <br />200405023 <br />Residence 3 09 W HEDDE APT 22 <br />GRAND ISLAND, NE 68801 -7185 <br />COURT RECORDING INFORMATION: <br />Liber Page - o - .,......_.,, Serial No , <br />2003 03936r-T903266927- 7200303936 <br />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refiling <br />of Assessment <br />(a) <br />/b) <br />fc) <br />(d) <br />(e) <br />/fJ <br />1040 <br />12/31/1993 <br />507 -64 -8320 <br />06/01/1998 <br />07/01/2008 <br />4568.86 <br />1040 <br />12/31/1994 <br />507 -64 -8320 <br />06/01/1998 <br />07/01/2008 <br />4433.14 <br />1040 <br />12/31/1996 <br />507 -64 -8320 <br />12/28/1998 <br />01/27/2009 <br />3653.43 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 12655.43 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 12th day of May <br />') nnA <br />Omaha, NE <br />, on this, <br />Signature a� Title Compliance Technical Support <br />d^`a. Manager <br />(MOTE: 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 (Z) (Rev. 10 -2000) <br />