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09/15/2004 17:11 FAX 14024714429 NEBRASKA UCC <br />X002/002 <br />200409179 <br />- - * - - <br />1872 DepartmeAt A"& & k�AA f `6Int&r%I !1RMn"utF Service <br />Form 668 (Z) Certificate of Release of Federal Tax Lien <br />(Rev. 10 -20001 <br />Serial Number For Use ! <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 399720315 "ES•••� <br />Lien Unit Phone: (651) 312 -8080 <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 December 01 9904350 <br />EIR SEN <br />1997 is authorized to note the books to show the release of this lien for Filed: el <br />these taxes and additions. <br />Name of Taxpayer <br />PATRICIA THOMSON EIHUSEN <br />Residence 2 8 08 BRENTWOOD BLVD <br />GRAND ISLAND, NE 68801 -7200 <br />Es <br />COURT RECORDING INFORMATION: <br />Liber Page UCC No. Serial No. <br />C r • �c:� � <br />I. <br />n/a n/a n/a 97- 110094 r ; j;f� , <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 />Reri6ng <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />1040 <br />12/31/1993 <br />507 -62 -0513 <br />09/23/1996 <br />10/23/2006 <br />5623.66 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at Omaha, NE <br />the 08th day of September, 2004 <br />Total 1$ 5623.66 <br />, on this, <br />Signature I Title Compliance Technical Support �— <br />� M, . k; Manager <br />(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Release of <br />FariwrRl Tax lien Rev. Rul. 71 -466, 1971 - 2 C.B. 4091 - Form 668 (Z) (Rev. 10 -2000) <br />