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Form 668 (Z) <br />(flee. 10 -2000) <br />5216 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 />850895112 <br />For Use by Recording Office <br />N6 sec of 5 a e John A Gale - UCC CRFTL <br />I certify that the following -named taxpayer, under the requirements of section 625 (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 />11 <br />1 <br />additions has been released. The proper officer in the office where the notice of <br />internal revenue tax lien was filed <br />on March 08 <br />x915758704 <br />-5 <br />Pee: <br />1 <br />2012 <br />, is authorized to note <br />the books to show the release of this lien for <br />Ma 07M30H 015 01:25 PM <br />these taxes and <br />additions. <br />Name of Taxpayer <br />TIMOTHY ONEILL <br />Residence1203 SYLVAN ST <br />GRAND ISLAND, NE 68801 <br />COURT RECORDING INFORMATION: <br />Liber Page <br />UCr Nn Serial <br />No. <br />n/a n/a <br />`9912686980 -6 201201819 <br />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refiling <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />6672 <br />03/31/2009 <br />XXX -XX -1860 <br />01/02/2012 <br />02/01/2022 <br />2650.30 <br />6672 <br />06/30/2009 <br />XXX -XX -1860 <br />01/02/2012 <br />02/01/2022 <br />6307.31 <br />6672 <br />09/30/2009 <br />XXX -XX -1860 <br />01/02/2012 <br />02/01/2022 <br />4406,76 <br />6672 <br />12/31/2009 <br />XXX -XX -1860 <br />01/02/2012 <br />02/01/2022 <br />3808.87 <br />6672 <br />03/31/2010 <br />XXX -XX --1860 <br />01/02/2012 <br />02/01/2022 <br />3374.57 <br />6672 <br />06/30/2010 <br />XXX -XX -1860 <br />01/02/2012 <br />02/01/2022 <br />3546.58 <br />6672 <br />09/30/2010 <br />XXX-XX-1863 <br />01/02/2012_ <br />02/01/2022 <br />3586.50 <br />6672 <br />03/31/2011 <br />XXX- XX-1860 <br />01/02/2012 <br />02/01/2022 <br />3046.79 <br />*********************************.********* <br />* * <br />* * * * * * * * * * **** <br />* * * * * * * * * ** * * ** <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 30727.68 <br />Grand Island, NE 68802 -1692 <br />0 <br />2015 05i6 36 <br />1 " <br />F, <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the <br />Signature <br />15th day of July <br />2015 <br />Title Director, Specialty Collections <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. Rut, 71 -466, 1971 - 2 C.B. 409) Form 669 (Z) (Rev. 10-2000) <br />Pant 1 - RECORDING OFFICE CAT. NC) 800261 <br />