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Jun. 14. 2017 3:i1PM NE Secretary of State — UCC <br />Form 668 (Z) <br />(Rev. t0 -2000) <br />11874 Department of the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 -6050 <br />Serial Number <br />821882011 <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 October 27 <br />2 011 , is to note the books to show the release of this lien for <br />these taxes and additions. <br />Name of Taxpayer <br />CORDON P BLAKE <br />Residence2455 LAMAR AVE <br />GRAND ISLAND, NE 68803' <br />Liber Page U <br />n/a n/a 9911675208 -5 <br />Kind of Tax <br />(a) <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />Place of Filing <br />the <br />Signature <br />Tax Period <br />Ending <br />(b) <br />09/30/2009 <br />12/31/2009 <br />03/31/2010 <br />06/30/2010 <br />09/30/2010 <br />24th day of May <br />COURT RECORDING INFORMATION: <br />o Serial No. <br />201108019 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />atebeit— <br />Identifying Number <br />(4J <br />XXX -XX - 0433 <br />XXX -XX -.0433 <br />XXX-XX -0433 <br />XXX -XX -0433 <br />XXX- XX- 0433 <br />* * * * * * * * * * * * *-v <br />2017 <br />Date of <br />Assessment <br />(d) <br />09/05/2011 <br />09/05/2011 <br />09/05/2011 <br />09/05/2011 <br />09/05/2011 <br />For Use <br />Last Day for <br />Refiing <br />(e) <br />10/05/2021 <br />10/05/2021 <br />10/05/2021 <br />10/05/2021 <br />10/05/2021 <br />Total $ <br />No. 1053 P. 7/10 <br />Title <br />Operations Manager, <br />Centralized Lien Operation <br />201703971 <br />by Recording Office <br />Y So. of 5kei. Jelin R Oslo - UC <br />9917793528 --8 Pas <br />BLAKE GORDON P <br />Filed: 06/14/2017 11:08 AM <br />Unpaid 'Balance <br />of Assessment <br />If) <br />8563.75 <br />10794.72 <br />12217.31 <br />10321.65 <br />13238.61 <br />55136.04 <br />This notice was prepared and signed at CHICAGO, IL , on this, <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. RUI. 71 -468, 1971 - 2 C.8. 409) Form 668 (Z) (Rev. 10-2000) <br />Part 1 - RECORDING OFFICE CAT. NO 600261 <br />ERCTL <br />