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V <br />Form 666 (Z) <br />fAev. 10 -2000) <br />5216 Department of the Treasury - Internal Revenue Service n Ll f � <br />Certificate of Release of Federal Tax Lien ll 11 V <br />Area: <br />Serial Number <br />For Use by Recording Office <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone; (800) 913 -6050 <br />514479509 <br />N A Aso of i4e4e <br />John a <br />6.1t - UCC CRFTL <br />I certify that.the following taxpayer, under the requirements of section 6325 (a) <br />of the Internal Revenue Code has satisfied the taxes listed below end all statutory <br />additions. Therefore, the lien provided by Code section 6321 for these taxes and <br />i 111 , <br />!F <br />1 <br />1111 <br />additions has been released The proper officer in the office where the notice of <br />- <br />internal revenue tax lien was filed <br />on February 19 <br />Ga 5 B Peg 1 <br />SEGURA SHENI n <br />the books to show the release of this ben for <br />2009 <br />, is authorized to note <br />f=iled: 02/1912016 0f3:4S AM <br />these taxes and <br />additions_ <br />Name of Taxpayer <br />SHENI M SEGURA CAMPOS <br />Residence 311 N LINCOLN AVE APT 6A <br />GRAND ISLAND, NE 68801 <br />COURT RECORDING INFORMATION: <br />Liber Page UCC No. Serial No. <br />n/a n/a 9909587439 -2 200901234 <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 />Refiiing <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />1040 <br />12/31/2005 <br />XXX -XX -4259 <br />09/18/2006 <br />10/18/2016 <br />1040 <br />12/31/2005 <br />XXX -XX -4259 <br />03/24/2008 <br />04/23/2018 <br />3321.25 <br />1040 <br />12/31/2006 <br />XXX -XX -4259 <br />04/15/2007 <br />05/15/2017 <br />1040 <br />12/31/2006 <br />XXX -XX -4259 <br />09/08/2008 <br />10/08/2018 <br />4214.73 <br />*********************************t********* <br />* * <br />* * * ** * * * * * * * <br />* * * * * * * * * * * * * * * ** <br />Place of Filing <br />Register of Deeds • <br />Hall POEOX 1692 Total <br />$ 7535.98 <br />Grand Island, NE 68802 -1692 <br />Feb, 19. 2016 2:11FM <br />NE Secretary of State — UCC <br />No. 5153 <br />F. 2/5 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the <br />Signature <br />03rd day of February 2016 <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. Rul. 71 -466, 1971 - 2 C.B. 409) Form 668 (Z) (Rev. 10 <br />Part 1 - RECORDING OFFICE CAT. NO 600261 <br />27 <br />