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Form 668 (Z) <br />fRev. 10-20001 <br />14583 Deportment 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; (600) 913-6050 <br />Serial Number _..____, <br />773353411 <br />For Use by Recording Office <br />N E Elk of Nisi. John R Isla - UCC CgrA. <br />I certify that the fallowing -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 Tien 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 />11111111111 11 <br />internal revenue tax lien was filed <br />on April 21 <br />2011 <br />is authorized to note <br />the books to show the release of this lien for <br />9914733273 -9 Pest 1 <br />, <br />REIS HEATHER E <br />these taxes and <br />additions. <br />Flied; 04402!2014 11.40 AM <br />Name of Taxpayer <br />HEATHER E REIS <br />201 401 864 <br />Residence 414 5 MANCHESTER RD <br />GRAND ISLAND, NE 68803 <br />COURT RECORDING INFORMATION: <br />!Aber Page UCC No. Serial No. <br />n/0- 11 /a 9911659528 -3 0201103043 <br />Tax Period <br />• <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Wiling <br />of Assessment <br />(a) <br />( <br />(a) <br />(d) <br />(a) <br />fq <br />6672 <br />06/30/2009 <br />XXX -XX -7020 <br />12/27/2010 <br />01/26/2021 <br />3570.24 <br />6672 <br />09/30/2009 <br />XXX -XX -7020 <br />12/27/2010 <br />01/26/2021 <br />4220.26 <br />6672 <br />12/31/2009 <br />XXX -XX -7020 <br />12/27/2010 <br />01/26/2021 <br />2746.98 <br />6672 <br />03/31/2010 <br />XXX -XX -7020 <br />12/27/2010 <br />01/26/2021 <br />2178.70 <br />a ir*************************** <br />**** <br />T********** **** <br />** **** ***N <br />**** * ** * *** ***,t* <br />Place of Filing <br />Register of Deeds <br />Ha11 POBOX 1692 Total <br />$ 12716.18 <br />Grand Island, NE 68802 -1692 <br />the <br />Apr. <br />Signature <br />2014 3:21FM1 NE Secretary of State — ACC <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />12th day of March , 2014 <br />No. 4122 F. 2/2 <br />Title <br />C orations Manager, <br />entralized .Case Processing-Lien Unit <br />(NOM 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. 4091 <br />�� OFFICE Form 668 (Z) (Rev. 10-2000) <br />CAT. NA RAnsei <br />