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07/08/2004 12:03 FAX 14024714429 NEBRASKA UCC <br />Form 10916(c) <br />(June 2000) <br />200406743 <br />Department of the Treasury - Internal Revenue Service <br />Withdrawal of Filed Notice of Federal Tax Lien <br />IM 002/002 <br />This certificate was prepared and signed at Omaha, Nebraska, on this, the 6th day of July, 2004. <br />Signature <br />Christopher Nebel, Employee # - 39 -00701 <br />Technical Advisor, Phone # - 402 - 221 -3404 <br />Form 10916(c) (Rev. § 2000) <br />erial Number <br />For Optional Use by Recording Office <br />_ <br />COu T ORDI NG I RMATI ON <br />CC9903296803 -1 <br />Small Business /Self Employed Area: 9 <br />r135615103 <br />I certify that as to the following -named taxpayer has met one or more of the elements of <br />the Internal Revenue Code (IRC) section 63230). The Internal Revenue Service therefore <br />withdraws the Notice of Federal Tax Lien for these taxes and additions. The withdrawal of <br />3 3 <br />this notice of lien does not affect the statutory lien provided by IRC section 6321; it simply <br />:.0 of s.... - ucc <br />relinquishes any lien priority obtained by the Internal Revenue Service when the notice <br />`�`T` <br />was filed. The proper official, in the office where the Notice of Federal Tax Lien was filed <br />on SEPTEMBER 30, 2003, is authorized to update the records to show the withdrawal of <br />the lien for these taxes and additions. <br />9904341263 -3 Peg: 1 <br />is ON07Q07/2004K11:00 <br />Name of Taxpayer <br />KATHLEEN K JOHNSON <br />qM <br />Residence <br />1620 W JOHN STREET <br />GRAND ISLAND, NEBRASKA 68801 <br />Kind of Tax <br />Tax Period Ended <br />Identifying Number <br />Date of <br />Last Day for <br />Unpaid Balance <br />(a) <br />(b) <br />(c) <br />Assessment <br />Refiling <br />of Assessment <br />(d) <br />(e) <br />(f) <br />940 <br />12131/2002 <br />47 -0845809 <br />09/08/2003 <br />$389.64 <br />941 <br />06/30/2002 <br />47- 0845809 <br />02/03/2003 <br />$5,424.36 <br />941 <br />09/30/2002 <br />47- 0845809 <br />09/08/2003 <br />$6,355.62 <br />941 <br />12/3112002 <br />47 -0845809 <br />.06/23/2003 <br />$2,496.80 <br />Place of Filing <br />Register of Deeds <br />Total <br />$14,666.42 <br />Hall County <br />Grand Island, Nebraska <br />This certificate was prepared and signed at Omaha, Nebraska, on this, the 6th day of July, 2004. <br />Signature <br />Christopher Nebel, Employee # - 39 -00701 <br />Technical Advisor, Phone # - 402 - 221 -3404 <br />Form 10916(c) (Rev. § 2000) <br />