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12/14/2004 17:52 FAX 14024714429 NEBRASKA UCC <br />1872 <br />Form 668 (Z) <br />(Rev. 10 -2000) <br />Department of.the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />10004/008 <br />Area: <br />Serial Number <br />For Use by Recording Office <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (651) 312 -8080 <br />183859904 <br />NE s.� ,r s�.k. - ucc TNe <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 03 <br />9904365815 -2 <br />2004 , is authorized to note the books to show the release of this lien for <br />DREI59gCH8 STEgKHOUSE INC, q C <br />Filsd; 12!14/2004 03;00 C, <br />these taxes and additions. <br />Name of Taxpayer <br />DREISBACHS STEAKHOUSE INC , a Corporation <br />c>, O O 1 /) O 1 <br />2 1 /w 1 <br />Residence 1137 S LOCUST ST <br />GRAND ISLAND, NE 68801-6771 <br />COURT RECORDING INFORMATION: <br />Liber Page UCC .,No_____ � Serial No. <br />n/a n/a C-3904344829- 200407712 <br />Tax Period <br />�� <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />,Assessment <br />Refilling <br />of.-Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />940 <br />12/31/2002 <br />47- 0530472 <br />05/24/2004 <br />06/23/2014 <br />712.41 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 712.41 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN , on this, <br />the 08th day of December 2004 C� `- <br />Signature Title Director, Payment Compliance <br />(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Reloase of <br />Federal Tax lien Rev. Rul. 71 -466, 1971 - 2 C. B. 40 9) Form 668 (Z) (Rev. 10 -2000) <br />- - ' . . o,... � _ a�rnonrtur. nFF10E r-nr nin annoav <br />