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Nov <br />c6 NG vc.,-, <br />Form 669 (Z) <br />(Rev. 10 -2000) <br />Area; <br />SMALL BUSZNES5 /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (B00) 913 - 6050 <br />Name of Taxpayer <br />BRUCE A SA CHRISTINE L OSENTOWSKI <br />Residence 4302 BLAUVELT RD <br />GRAND ISLAND, NE 68803 -1401 <br />Tax al� eriod <br />Kind of Tax Ending <br />(a) (b) <br />Place of Filing <br />This notice was prepared and signed :3t <br />the 25th day of October 2017 <br />Signature <br />7. 2017 3:42PM NE Secretary of State — UCC <br />2284 Department of the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />Identifying Number <br />(c) <br />Serial Number <br />274991117 <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 sectlort 8321 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 August 29 <br />2 017 , ig authorized to note the books to show the release of this lien for <br />these taxes and additions_ <br />COURT RECORDING INFORMATION: <br />Liber Page UC Serial No. <br />n/a n/a 9917797244 - 0T 201705834 <br />Date of <br />Assessment <br />(d) <br />1040 12/31/2015 XXX -XX -7329 11/07/2016 <br />** l *** ** ** * *** * ** * * * * * *** * * * * * * * ** <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 65802-1692 <br />CHICAGO, IL <br />Last For <br />ng <br />(a) <br />No, 2545 P. 3/3 <br />201707624 <br />For Use by Recording Office <br />NE Sec of 5ie6e Jehn N Eats UCC CEF7L <br />9917801313 -8 Pas: <br />OSENTOW51(I BRUCE <br />Filed: 11/07/2017 0;15 PA <br />Unpaid Balance <br />of Assessrent <br />If) <br />12/07/2026 30465.47 <br />Total $ 30465.47 <br />, on this, <br />Title <br />Operations Manager, Centralized <br />Lien Operation <br />(ROTA Certificate of officer authorized by law to take acknowledgments la not essential to the validity of Certificate of Release of <br />Federal Tax lien Rev. Rul. 71 -466, 1971 - 2 C.B. 4091 Form 669 (Z) (Rev. 10-2000) <br />Part I - RECORDING OFFICE CAT, NO 500261 <br />