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<br />08/21/2007 TUE 15:59 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />f4J004/012 <br /> <br />O\orm~'~;-(Z) <br /> <br />(Rev. 10-2000) <br /> <br />1924 <br /> <br />Department of the Treasury ~ Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br /> <br />200707172 <br /> <br />Area: Serial Number. <br />SMALL BUSINESS/SELF EMPLOY~D.AREA #1 <br />Lien Unit Phone: (800) 913-6050 267975506 <br /> <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 January 24 <br />2006 ,is authorized to note the books to show the release. of this lien for <br />these taxes and additions. <br /> <br />Name of Taxpayer <br />G DOUGLAS CAMPLIN DDS PC , a Corporation <br /> <br />For Use b <br /> <br /> <br /> <br />Residence 2516 COTTONWOOD <br />GRAND ISLAND, NE 68801 <br /> <br />COURT RECORDING. INFORMATION: <br />Liber _ Page uee No. Serial No_ <br />2006 00731 9906434475-8 -200600731 <br /> <br />Tax Period Date of <br />Ending Identifying Number Assessment <br />(b) (e) (d) <br />12/31/2004 47-0752368 12/05/2005 <br />******** -********** ************* ********** <br /> <br />Kind of Tax <br />(a) <br />941 <br /> <br />Last Day for <br />ReriOnl' <br />(8) <br />01/04/2016 <br />************ <br /> <br />Unpaid Balance <br />of Assessment <br />({) <br />8917.06 <br />**************** <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br /> <br />Total $- <br /> <br />8917.06 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />the <br /> <br />Olst day of November <br /> <br />2006 <br /> <br />Signature <br /> <br /> <br />Title Director, Campus Compliance <br />Operations <br /> <br />(NOTE: Certificate of officer authorized by law to -~ake acknowledgments is not essential to the validity of Certificate of Release of <br />Federal Tax lien Rev. RuL 71.466,1971.2 C.B. 4091 <br />Part t . RECORDING OffiCE <br /> <br />Form 668 (Z) (Rev. .'0-2000) <br />CAT. NO 600261 <br /> <br />'Y <br />