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L <br />12/14/2004 17:54 FAX 14024714429 NEBRASKA UCC <br />Form 668 (Z) <br />(Rev. 10 -2000) <br />F I— F _ <br />1872 Department o t e reasurji - era e e ue Service <br />Certificate of Release of Federal Tax Lien <br />Area: Serial Number <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 390367623 <br />Lien Unit Phone: (651) 312 -8060 <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 March 14 <br />2003 , is authorized to note the books to show the release of this lien for <br />these taxes and additions. <br />Name of Taxpayer <br />DREISBACHS STEAKHOUSE INC , a Corporation <br />Residence 1609 SPRING RD <br />GRAND ISLAND, NE 68801 -7039 <br />Z 007/008 <br />For Use by Recording Office <br />.4 54.4. - ucc TO! <br />65839 -0 Pus: 1 <br />ACHS STEAKHOUSE INC, A C <br />12/14/2004 03:00 PM <br />200412015 <br />COURT RECORDING INFORMATION: <br />Liber Page UCC .o _ .� _., Serial No. <br />2003 02964 C9`_C_- 3263402 - 2'00302964 <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 />Refifing <br />of Assessment <br />(a) <br />(b) <br />(C) <br />(d) <br />(e) <br />(f) <br />941 <br />09/30/2002 <br />47- 0530472 <br />11/25/2002 <br />12/25/2012 <br />6294.17 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />Omaha, NE <br />This notice was prepared and signed at — <br />the 08th day of December 2004 <br />Total e $ <br />6294.17 <br />on this, <br />s <br />r � <br />J <br />Lrt <br />Signature Title Director, .Payment Compliance <br />(NOTE: Certificate of officer authorized by law to take acknowiedgments is not essentiat to the validity or UerTITIGBT6 u1 <br />Federal Tax lien Rev. Rul. 71 -466, 1971 - 2 C.B. 409) . Form 668 (Z) (Rev. 10 -2000) <br />o.,,. t - RFr.nRDING OFFICE r,or Kin ann ?at <br />