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Oct, 35. 2015 2:53FM NE Secretary of State — UCC • <br />Form 668 (Z) <br />(Rev 10 -7000) <br />Area: <br />WAGE E. INVESTMENT AREA #2 <br />Lien Unit Phone: (800) 913 -6050 <br />Name of Taxpayer <br />TAMERA S JACOBSON <br />Residence2323 BELLWOOD DR <br />GRAND ISLAND, NE 68801 -8205. <br />Liber Page C <br />n/a n/a 9909595577 -4 <br />Kind of Tax <br />(a) <br />. 1040 <br />Place of Filing <br />Tax Period <br />Ending <br />(b) <br />12/31/2003 <br />* * * * * * * * * * ** <br />the <br />Signature <br />5216 Department of the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />For Use by Recording Office <br />Identifying Number <br />(c) <br />XXX -XX -9365 <br />* * * * ** *•tar * * * ** <br />14th day of . October , 2015 • <br />°..,1Y' e,N-ate <br />Serial Number <br />541131209 <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 May 05 <br />2009 , is authorized to note the books to show the release of this lien for <br />these taxes and additions. <br />COURT RECORDING INFORMATION: <br />N• Serial No. <br />200903469 <br />Date of <br />Assessment <br />(d) <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />Last Day for <br />Refiling <br />(a) <br />u . 3379 <br />NE See of 54ate John A Gal <br />9915763186 -2 <br />JACOBSON TRMERR <br />Flied: 10!3012015 01:58 PM <br />Total $ <br />201507467 <br />Ucc <br />Pgs: <br />Unpaid Balance <br />of Assessment <br />(f) <br />GRAIL <br />05/19/2008 06/18/2018 9603.83 <br />* * * * ** * * ** *t ****** ***- ear *** *** ** *tar; ** ** <br />9603.83 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />Title Director, Specialty Collections <br />(NOTE: Certificate of officer authori2ed by law to take acknowledgments is not essential to the validity of Certificate of Release of <br />Federal Tex lien Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668 (Z) (Rev. 102000) <br />Part 1 = RF,CORDING OFFICE CAT. NO 600261 <br />