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Form 668 Z <br />(Rev. 10 -20001 <br />5216 Department of the Treasury - Internal Revenue Service 201,6011: <br />Certificate of Release of Federal Tax Lien <br />Area: <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone: (800) 913 -6050 <br />Serial Number <br />529535709 <br />For Use by Recording Office <br />NE Sec of S4 4e John N 6ele - YCC CRCTL <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 />�i <br />additions, Therefore, the lien provided by Code section 6321 for these taxes and <br />I1 <br />additions has been released, The proper officer in the office where the notice of <br />internal revenue tax lien was filed <br />on April 09 <br />2009 <br />, is authorized to note <br />the. books to show the release of this lien for <br />9916789176 -3 Pga: 1 <br />these taxes and <br />additions. <br />Fi l e d: 02 /2 01;07 PM JN <br />Name of Taxpayer <br />MARY JEAN MOBNIKE <br />Residence 1319 PARK AVE <br />GRAND' ISLAND, NE 68803 -3044 <br />COURT RECORDING INFORMATION: <br />Liber Page <br />T1 rr _In Serial <br />No. <br />n/a n/a <br />9909592725 -0 200902610 <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 />fat <br />(b) <br />fel <br />(d) <br />fe) <br />(f) <br />1040 <br />12/31/2000 <br />XXX -XX -5239 <br />06/11/2007 <br />07/11/2017 <br />17052.67 <br />1040 <br />12/31/2002 <br />XXX-XX-5239 <br />06/11/2007 <br />07/11/2017 <br />391.80 <br />*-** ** * * **** <br />** ** ** * * * <br />• <br />* * * * * ** *** * * *, <br />********** * <br />*** ** * ***** ** <br />*,k * * * * * ******* ** <br />Place of Filing . <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 17444.47 <br />Grand Island, NE 68802 -1692 <br />Feb. 25. 2016 3:24PM NE Secretary of State — UCC <br />This notice was prepared and signed at CHICAGO, IL <br />on this, <br />the <br />10th day of February <br />Signature <br />C v.- J,.n.T <br />2016, <br />No. 5260 F. 3/3 <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 -2000) <br />Part 1 - RECORDING OFFICE CAT. NO 600261 <br />