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form ~ t~~ ~ (~~y}y~ (aDaV}aprtm/eynftof-Ahs Trps+a~a~uery-I.najmal ~Ryayv(epnu~e~yServ~(ic+e~y Fp~q; - 1Rev. SAPtemberl9]$ . _- ~ i~ Y~GI IHfV~1FS iF1~ '~~V®'a?~ Qfi ~~j~iiar {a~ t QaA ~[Yrt, -' t -- _ District 'rt ` Seilal Numtaer ~~ Fo. a~tra,•e~r use r ae ' my onrce t certify ttaaf as to the foElowing-named tazpayer, the requirements of sec4i- on 8325{a) -~ of the tntemai Revenue Cade have heart satisfiied for the taxes listed below and for alt sta>~tory additions. therefore, the tien prrnrided by.Code sedion 6321 far ; these faxes and additions ,bas been released. The proper offic ~r in t office ! j where the ratite of internal Tevenue fax't-tea was filed on_L~ _~_, 19! 19!x, is authorized to note the books to show the release of this lien for these 'taxes and additions. ~~~ f tdame of Taxpayer _ / ~ i Residence i ~ ~ unpaid Balance Kind at lax ~ Tax Period Ended Date of Assessment Identifying ~fumtwr of Assessment (eT I tb) i fc! ~ tW ~ (s1 ~~ ~ ~ ~ ~ ~ ! . ~ ~ i i ', ', ~ ~ ~~ ~# ~.....>< 'f.~.aaa rods. Omaha, '!etaraska This eertifica' .i was prepared and signed.at ._ _. _.____,.____...___.._.__.___ the_ 17thday of _ _P'.dreh_..ts -._._ SO Tatal ~ ~ on this, Don~Td J. Ehlers Chief, Special 1'roce~ures (WgEa; CaHrrioata OP OnkM aWhoriiad IDY !aW fo roka ecknowietlpmants 1! fl01 aMMltlal !a me Vtll(UI[T W N6Ce;a of FaQaial T1u flan O.C.M. tbOr4. :pg6 r, C.a. t32!„ Pm! 3 - To tae used far r®cordMg purpps+Ets, i=4nn 61i$ {Rev. a.79}