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Form 668 (Z) <br />(Rev, 1()-2000) <br />3595 Department of the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (BOO) 913 -6050 <br />Serial Number <br />, <br />810625711 <br />For Use by Recording Office <br />NE goo of 6 1aka loom A OaIO - ucc CNCTL <br />I certify that the following -named taxpayer, <br />of t he Internal Revenue Code has <br />additions. Therefore, the lien provided <br />has been released. The <br />revenue tax lien was filed <br />under the requirements of section 6325 (a) <br />satisfied the taxes listed below and all statutory <br />by Code section 6321 for these taxes and <br />proper officer in the office where the notice of <br />September <br />on Se tember 08 <br />9913'�3A4 <br />d <br />�i��, <br />���� <br />;� <br />, <br />- I <br />11 ,1 <br />1 ' <br />7 <br />' <br />o �! IHI <br />1 <br />� �additions <br />I !i � ��internal <br />;III fly ! <br />gds, I <br />the books to show the release this lien for <br />2011 <br />is authorized to note <br />BETHANY <br />, of <br />Fil B <br />Filed; 89/20/2013 12:60 PM <br />these taxes and <br />additions. <br />Name of Taxpayer <br />. A <br />BETHANY ROZENDAL <br />t1 , <br />Residence 612 W 16TH ST <br />GRAND ISLAND, NE 68801 -3514 <br />COURT RECORDING INFORMATION: <br />Liber Page UCC Serial No. <br />n/a n/a 9911671152- <br />201106700 <br />' <br />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Bomber <br />Assessment <br />Reuling <br />of Assessment <br />(a) <br />fb) <br />(c) <br />(d) <br />(e) <br />(fl <br />1040 <br />12/31/2009 <br />XXX -XX -9298 <br />07/25/2011 <br />08/24/2021 <br />686.28 <br />1040 <br />12/31/2010 <br />XXX -XX -9298 <br />07/18/2011 <br />08/17/2021 <br />4730.36 <br />* * * * ** * * <br />* * * * * * * * * * * * <br />** * * * * * * * * * *v <br />*, ******** * <br />* * * * * * * *** * ** <br />* * *,t * * * * ** ** * * ** <br />• <br />• <br />Place of Filing . <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 5416.64 <br />. Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at CHICAGO, IL <br />on this, <br />• Sep. 20. 2013 2:36PM NE Secretary of State — UCC <br />the <br />Signature <br />04th day of September, 2013 <br />No. 1014 P. 2 <br />Title <br />Operations Manager, <br />Centralized Case Processing -Lien Unit <br />(NOTE; Certificate of officer authorized by law to take acknowledgments is not essandal to the validity of Certificate of Release of <br />Federal Tax lien Rev. Rul. 71 -466, 1971 - 2 C.9. 409) Form 668 (Z) (Rev. 10-2000) <br />' Part I - RECORDING OFFICE CAT. NO 600261 \1,/ <br />