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NE Sec of State - Robert B. Evnen <br />Filing Document #: 2212001046-6 Pages: 1 <br />Debtor Name: SHANNON CROSBY <br />Filing Date and Time: 12/29/2022 10:05 AM <br />J <br />202208888 <br />--*-- <br />Form 668 (Z) <br />!Rev. 10,2000)Certificate <br />17628 Department of the Treasury - Internal Revenue Service <br />of Release of Federal Tax Lien <br />Area: <br />Serial Number <br />For Use by Recording Office <br />SMALL SJSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-60S0 <br />221396116 <br />I certify that the following named taxpayer, under the requirements of section 6325 lay <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 Tien was filed <br />on July 29 <br />2016 , is authorized to note <br />............................................... <br />the books to show the release of this lien for <br />these taxes and additions, <br />Name of Taxpayer <br />- <br />SHANNON CROSBY <br />Residence2680 SAINT PATRICK AVE <br />GRAND ISLAND, NE 68803-1307 <br />COURT RECORDING INFORMATION: <br />Liber Page UCC No. Serial No. <br />n/a n/a 201604875 9916777669-4 <br />Tax Period <br />Date of <br />Last <br />Day for <br />Unpaid Batance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refiling <br />of Assessment <br />(a} <br />(b) <br />(c/ <br />(d) <br />(e) <br />(17 <br />6672 <br />09/30/2008 <br />XXX -XX -4476 <br />12/14/2015 <br />01/13/2026 <br />2307.18 <br />6672 <br />12/31/2008 <br />XXX -XX -4476 <br />12/14/2015 <br />01/13/2026 <br />2793.14 <br />6672 <br />03/31/2009 <br />XXX -XX -4476 <br />12/14/2015 <br />01/13/2026 <br />1925.84 <br />6672 <br />06/30/2009 <br />XXX -XX -4476 <br />12/14/2015 <br />01/13/2026 <br />1572.58 <br />6672 <br />09/30/2009 <br />XXX -XX -4476 <br />12/14/2015 <br />01/13/2026 <br />1518.31 <br />* * * * * * * * <br />* * * * * * * * * * * * <br />* * * * * * * * * * * * * <br />, k * * * * * * * * * * <br />* * * * * * * * * * * * <br />w• * * <br />* * * * * * * * * * * * * * <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ <br />10117.05 <br />Grand Island, NE 68802-1692 <br />CHICAGO, IL <br />This notice was prepared and signed at , on this, <br />the 16th day of December 2022. <br />Signature <br />04.„eu,amer <br />Title <br />Operations Manager, <br />Centralized Lien Operation <br />(NOTE: Certificate of officer authorized by law 10 take acknowledgments is not essential to the validity of Certificate of Release of <br />Federal Tax lien Rev. Rui. 71-466, 1971 - 2 C.B. 4091 <br />Part 1 - RECORDING OFFICE Form 668 (Z) (Rev. 10-20001 <br />CAT. NO 600261 <br />