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202101824 <br />NE Sec of State - Robert B. Evncn <br />Filing Document #: 2103000267-3 Pages: 1 <br />Debtor Name: TIMOTHY MCMULLEN <br />Filing Date and Time: 03/04/2021 10:10 AM <br />Form 668 (Z) <br />(Rev. 10.2000) <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 04 <br />Lien Unit Phone: (800) 913-6050 <br />403390320 <br />I certify that the following -named taxpayer, under the requirements of section 6325 la) <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 <br />on Januaa <br />30 <br />2020 <br />, is authorized to note <br />the books to <br />show <br />the release of this lien for <br />these taxes and <br />additions. <br />Name of Taxpayer <br />TIMOTHY MCMULLEN <br />Residence819 W 12TH ST <br />GRAND ISLAND, NE 68801-3718 <br />COURT RECORDING INFORMATION: <br />Liber Page USC -_NSI Serial No. <br />n/a n/a 2001001677 1, 202000722 <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 />Refdbtg <br />of Assessment <br />(a0 <br />(b) <br />(c) <br />(dl <br />(el <br />Ul <br />CIVP <br />12/31/2016 <br />XXX -XX -0240 <br />05/21/2018 <br />06/20/2028 <br />1037.77 <br />CIVP <br />03/31/2017 <br />XXX -XX -0240 <br />12/12/2018 <br />01/11/2029 <br />4075.69 <br />CIVP <br />06/30/2017 <br />XXX -XX -0240 <br />05/21/2018 <br />06/20/2028 <br />3219.76 <br />CIVP <br />09/30/2017 <br />XXX -XX -0240 <br />05/21/2018 <br />06/20/2028 <br />3964.78 <br />**************r*****•**********•* <br />r*•***********r*,t***•*******************• <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 12298.00 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />CHICAGO, IL <br />the 30th day of December , 2020. <br />Signature <br />Title <br />Operations Manager, <br />Centralized Lien Operation <br />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. Rul. 71-466, 1971 - 2 C.B. 409) Form 668 (Z) (Rev. 10-2000) <br />Part I - RECORDING OFFICE CAT. NO 600261 <br />