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202007512. <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2010000050-6 Pages: 1 <br />Debtor Name: SHANNON CROSBY <br />Filing Date and Time: 10/02/2020 09:04 AM <br />Form 668 (Z) <br />tU' <br />iRev. 10 2000I <br />17505 Department of the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />Area: <br />Serial Number <br />For Use by Recording Office <br />SMALL BUSINESS/SELF EMPLOYED AREA #6 <br />Lien Unit Phone: (860) 913-6000 <br />321611018 <br />I certify that the following -named taxpayer, under the requirements of section 6325 fa) <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 otticer in the office where the notice of <br />internal revenue tax lien was filed <br />on September 07 <br />2018is authorized to note <br />the books to show the release of this lien for <br />these taxes and additions. <br />Name of Taxpayer <br />SHANNON CROSBY <br />Residence3763 W CAPITAL AVE APT N313 <br />GRAND ISLAND, NE 68803-1307 <br />COURT RECORDING INFORMATION: <br />Liber Page UCC No. Serial. No. <br />n/a n/a 19918619104.3 201.805888 <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 />fel <br />(b) <br />(c) <br />(d) <br />(e) <br />Nl <br />6672 <br />09/30/2015 <br />XXX -XX -4476 <br />08/13/2018 <br />09/12/2028 <br />7353.70 <br />6672 <br />12/31/2015 <br />XXX -XX -4476 <br />08/13/2018 <br />09/12/2028 <br />8508.12 <br />6672 <br />03/31/2016 <br />XXX -XX -4476 <br />08/13/2018 <br />09/12/2028 <br />9243.69 <br />6672 <br />06/30/2015 <br />XXX -XX -4476 <br />08/13/2018 <br />09/12/2028 <br />9989.71 <br />6672 <br />09/30/2016 <br />XXX -XX -44.76 <br />08/13/2018 <br />09/12/2028 <br />11092.43 <br />6672 <br />12/31/2016 <br />XXX -XX -4476 <br />08/13/2018 <br />09/12/2028 <br />9600.83 <br />6672 <br />03/31/2017 <br />XXX -XX -4476 <br />08/13/2018 <br />09/12/2028 <br />9167.86 <br />6672 <br />06/30/2017 <br />XXX--XX-4476 <br />08/13/2018 <br />09/12/2028 <br />8597.53 <br />***********c*tie;t********+,,a**************:t**,w**,t**,t*******.**************** <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 73553.87 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />the <br />19th day of September, 2020, <br />7.H <br />, on this, <br />Signature <br />Tide <br />Operations Manager, <br />Centralized Lien Operation <br />(NOTE: Cort loot,: al of tit;ar a tthttneee! h' lava lo lake= acl nOrrl ;Et ttt t:rt£s is 0-4 r 9cc r£ia€ to Ihz tI fitly of C.oi1 if,r:o£r, of Rr;lranse of <br />Federal fax lien hay. Rol. 71-466, 1971 - 2 C.0. 4091 Farm 668 (Z) (Rev. 10 20iYJi <br />Part 1 - RECORDING OFFICE CAT. NO 600261 <br />