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- <br />Form 10916 <br />(Februar 20111 <br />5216 Department of the Treasury - internal Revenue Service <br />201601( <br />Withdrawal of Filed Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SEL1: MPI,OYED AREA #4 <br />Lien Unit Phone: (800) 913 -6050 <br />Serial Number <br />944141313 <br />For Optional Use by Recording Office <br />N E Sae of Sia4a John R 0.1r U[[ NFTL <br />I certify that the following -named taxpayer has met one or more of the elements <br />of the internal Revenue Code (IRC) section 6323(1). The Internal Revenue Service <br />therefore withdraws the Notice of Federal Tax Lien for these taxes and additions. <br />Il <br />The withdrawal of this notice of lien does not affect the statutory lien provided <br />I <br />by IRC section 632 I; it simply relinquishes any lien priority obtained by the Internal <br />it <br />Revenue Service when the notice was filed. The proper official, hi the office where <br />9918768857 - Z <br />Pea; 1 <br />the Notice of Federal Tax Lien was <br />filed on June 24, 2013 , <br />SIEMERS HERTHER <br />is authorized to update the records <br />to show the withdrawal of the notice of lien <br />Fi 1od : 02/19/2018 09:45 AM <br />for these taxes and additions. <br />Name of Taxpayer <br />RICHARD & HEATHER SIEMERS <br />Residence 114 E 22ND ST <br />GRAND ISLAND, NE 68801 -2329 <br />COURT RECORDING INFORMATION; <br />Liber Page UCC No. Serial No. <br />n/a nJa 99137173 - 2 201305036 <br />- <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 />Refi ling <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(1) <br />1040 <br />12/31/2009 <br />XXX -XX -1698 <br />02/20/2012 <br />03/22/2022 <br />11643.49 <br />1040 <br />12/31/2010 <br />XXX -XX -1698 <br />04/15/2013 <br />05/15/2023 <br />74245.21 <br />* * * * * * * <br />* ***** ***** <br />*fir * * * * * * * * * ** <br />fr******** ** <br />** * * * * * * * * ** <br />k****** * * * * * * * * ** <br />• <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 85888.70 <br />Grand Island, NE 68802 -1692 <br />• <br />the <br />Feb. 19. 2516 2:11PM <br />This certificate was prepared and signed at <br />04th day of February 2016 <br />Signature <br />N r‘-Attft-r" <br />Catalog Number 24588T Part 1 - Recording Office <br />NE :rotary of State — UCC <br />Nc.5153 F. 4/5 <br />CHICAGO, IL , on this, <br />Title Director, Specialty Collections <br />www.irs.gov Form 10916 (2 -2012) <br />2 <br />