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202501228 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2503000488-0 Pages: 1 <br />Debtor Name: ROSEMARY BLAKE <br />Filing Date and Time: 03/11/2025 09:20 AM <br />03/10/2025 2:39:02 PM -0406 IRS <br />• PAGE 3 OF 7 <br />Form 668 (Z) <br />IR*v. 10-20001 <br />5191 Department of the Treasury - internal Revenue Service <br />Certificate of Release of Federal Tax Lien <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA #6 <br />Lien Unit Phone: (800) 913-6050 <br />Serial Number <br />433114621 <br />For Use by Recording Office <br />I certify that the <br />of the Internal <br />additions. Therefore. <br />additions has <br />internal revenue <br />2021 , <br />following -named taxpayer, <br />Revenue Code has <br />the lien provided <br />been released. The <br />tax lien was filed <br />is authorized to note <br />additions. <br />under the requirements of section 6325 <br />satisfied the taxes listed below and ill statutory <br />by Code section 6321 for these taxes <br />proper officer In the office where the notice <br />on July 01 <br />(a) <br />and <br />of <br />for <br />the books to show the release of this lien <br />these taxes and <br />Name of Taxpayer <br />ROSEMARY SLAKE <br />Residence2455 LAMAR AVE <br />GRAND ISLAND, NE 68803-6233 <br />COURT RECORDING INFORMATION: <br />Liber Page UCC No. Serial No. <br />n/a n/a 2107000008-8 202105635 <br />Khtd of Tax <br />II, <br />Tax Period <br />(hI <br />Identifying Number <br />(ci <br />Date of <br />Assessment <br />ldl <br />Last <br />fat' <br />(el <br />Unpaid Sainte <br />of Apt <br />/0 <br />6672 <br />6672 <br />6672 <br />********************** <br />03/31/2019 <br />06/30/2019 <br />09/30/2019 <br />XXX-XX-5054 <br />XXX-XX-5054 <br />XXX-XX-5054 <br />****.***********.************ <br />04/05/2021 <br />04/05/2021 <br />04/05/2021 <br />05/05/2031 <br />05/05/2031 <br />OS/05/2031 <br />1096,96 <br />10927.93 <br />5828.79 <br />t*************•** <br />Piece of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802.1692 <br />$ 17953.68 <br />This notice was prepared end signed at CHICAGO1 IL <br />the <br />24th day of January , 2025. <br />, on this, <br />Signature <br />Title <br />Operations Manager, <br />entralized Lien Operation <br />(NOTE: Certificate or officer awheittsd by law to take acknowledgments is not essent;ei to ova vaNdty of Csetifieste of Rehm* or <br />Federal Tax Fen Rev. Rut. 71 486, 1971 2 C.8. 409) • Foam 6611(t) (Rev. 10-2000) <br />Part I * RECORDING OFFICE CAT. NO 800281 <br />