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NE Sec of State - Robert B. Evnen <br />Filing Document #: 21 120001 12-2 Pag@s: I <br />Debtor Name: FERNANDO VALENZUELA RODRIGUEZ <br />Filing Date and Time: 12/02/2021 09:37 AM <br />202110243 <br />Form 668 (Z) <br />(Rev. 102000) <br />1654 Department of the Treasury - Internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA 04 <br />Lien Unit Phone: (800) 913-6050 <br />Serial Number <br />354808919 <br />For Use by Recording Office <br />I certify that the following -named taxpayer, <br />of the Internal Revenue Code has <br />additions. Therefore, the lien provided <br />additions has been released. The <br />internal revenue tax lien was filed <br />2019 , is authorized to note <br />these taxes and additions. <br />under the requirements of section 6325 (a) <br />satisfied the taxes listed below and all statutory <br />by Code section 6321 for these taxes and <br />proper officer in the office where the notice of <br />on May 29 <br />the books to show the release of this lien for <br />Name of Taxpayer <br />FERNANDO VALENZUELA RODRIGUEZ <br />Residence816 S PINE ST <br />GRAND ISLAND, NE 68801-7943 <br />COURT RECORDING INFORMATION: <br />Liber Page UCC No. Serial No. <br />n/a n/a 1905001655-4 201903040 <br />Kind of Tax <br />(a) <br />Tax Period <br />Ending <br />(6) <br />Identifying Number <br />(cl <br />Date of <br />Assessment <br />(dl <br />Last Day for <br />Refiling <br />fel <br />Unpaid Balance <br />of Assessment <br />(f) <br />1040 <br />1040 <br />**************************a******.**************,r********r**************** <br />12/31/2016 <br />12/31/2017 <br />XXX -XX -4151 <br />XXX -XX -4151 <br />06/05/2017 <br />06/11/2018 <br />07/05/2027 <br />07/11/2028 <br />10349.93 <br />15508.34 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802-1692 <br />$ 25858.27 <br />This notice was prepared and signed at <br />CHICAGO, IL <br />the 10th day of November , 2021, <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. 4091 Form 668 (Z) (Rev. 10.20001 <br />Part f - RECORDING OFFICE CAT. NO 600261 <br />