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Mar.29. 2017 3:36PM NE Secretary :f 'State — UCC <br />• <br />ow <br />Form 668 (Z) <br />(Aev. 10 -2000) <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 - 6050 <br />Name of Taxpayer <br />JEREMY L & KIMBERLY A JENSEN <br />Residence 2207 WOODRIDGE LN <br />GRAND ISLAND, NE 68801-7234 <br />Liber Page <br />n/a n/a <br />Kind of Tax <br />1040 12/31/2014 <br />1040 12/31/2015 <br />* * * * * * * * * * * * * * ** ** ** <br />Place of Filing <br />This notice was, prepared and signed at <br />the <br />Signature <br />11874 Department of the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />Tax Period <br />Ending <br />!bl <br />15th day of March <br />identifying Number <br />(c) <br />KKK -XX -3427 <br />XXX -XX -3427 <br />2017 <br />Serial Number <br />245267217 <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 February 03 <br />2017 , Is authorized to note the books to show the release of this lien for <br />these taxes and additions. <br />COURT RECORDING INFORMATION: <br />UCC No. Serial No. <br />(5 5- 201700794 <br />Date of <br />Assessment <br />(d) <br />11/23/20 <br />11/21/2016 <br />* * * * * * * ** ** <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />CHICAGO, IL <br />Lan Day for <br />Reflling <br />(e) <br />No. 0222 P. 2/5 <br />®1'70193 <br />For Use by Recording Office <br />We Sec ve Skate John R 0.l+ - uct CRFTL <br />NN <br />9917799439 -3 P9s: 1 <br />JENSEN JEREMY L <br />Filed: 03/29/2017 01:0W PM <br />Unpaid Balance <br />of Assessment <br />(f) <br />12/23/2025 5297.65 <br />12/21/2026 30140.74 <br />* * * * * * * * * * * *' * * ** * * * * * * * ** * ** <br />Total $ 35438.39 <br />Title <br />Operations Manager, <br />centralized Lien Operation <br />, on this, <br />(NOTE: Certificate of officer authorized by lew to take acknowledgments is not essential to the validity of Certificate of Release of <br />