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04/24/2013 WED 15:26 FAX 402 471 4429 UCC SECRETARY OF STATE ---.-» Hall <br />�b <br />Form 668 (Z) <br />(Rev. 10 -2000) <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #1 <br />Lien Unit Phone: (800) 913 - 6050 <br />Name of Taxpayer <br />PETER J & SHANE KOSZALKOWSKI <br />Residence 210 CAMPBELL AVE <br />DONIPHAN, NE 68832 -9787 <br />COURT RECORDING INFORMATION: <br />Liber Page U Serial No. <br />n/a n/a 9 -0 201204696 <br />Kind of Tax <br />(a) <br />1040 <br />1040 <br />1040 <br />1040 <br />* * * * * * ** <br />Place of Filing <br />the <br />Signature <br />3595 Department of the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />Tax Period <br />Ending <br />(b) <br />12/31/1999 <br />12/31/2000 <br />12/31/2001 <br />12/31/2002 <br />* * * * * * * * * * ** <br />15th day of April <br />Identifying Number <br />(c) <br />XXX -XX -4854 <br />XXX -XX -4854 <br />XXX - XX- 4 8 5 4 <br />XXX -XX -4854 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />2013, <br />Serial Number <br />872079712 <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 June 12 <br />2012 , is authorized to note the books to show the release of this lien for <br />these taxes and additions. <br />Date of <br />Assessment <br />(d) <br />07/09/2007 <br />07/16/2007 <br />07/30/2007 <br />08/06/2007 <br />* * * * * * * * * * * * * * * * * * * * * * * ** <br />20130324 <br />Last Day for <br />Reuling <br />(e) <br />For Use by Recording Office <br />NE Sec of Stole John R Gale - UCC CRFTL 1 11 <br />- <br />9913713721 -4 P9s: 1 <br />KO5ZALKOWSKI PETER 3 <br />Filed: 04/24/2013 12:13 PM <br />Unpaid Balance <br />of Assessment <br />(f) <br />08/08/2017 3913.39 <br />08/15/2017 16687.53 <br />08/29/2017 7459.63 <br />09/05/2017 1117.02 <br />* * * * * * * * * * * *w * * * * * * * * * * * * * * ** <br />Total $ 29177.57 <br />This notice was prepared and signed at CHICAGO, IL <br />2004/004 <br />, on this, <br />Title <br />Operations Manager, <br />Centralized Case Processing -Lien Unit <br />(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Release of <br />Federal Tax lien Rev. Rul. 71 -466, 1971 - 2 C.B. 409) <br />Part 1 - RECORDING OFFICE Form 668 (Z) (Rev. 10 - 2000) <br />CAT. NO 600261 <br />