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20250 687 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2504000118-3 Pages: 1 <br />Debtor Name: ROSEMARY BLAKE <br />Filing Date and Time: 04/04/2025 08:46 AM <br />Form 668 (Z) <br />!Rev. 10-20001 <br />3005 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 8325 (a) <br />satisfied the taxes listed below and all statutory <br />by Code section 8321 for these taxes and <br />proper officer in the office where the notice of <br />on July 01 <br />the books to show the release of this lien for <br />these taxes and <br />Name of Taxpayer <br />ROSEMARY BLAKE <br />Residence 2455 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 />Kind of Tax <br />(a) <br />Tax Period <br />Ending <br />(b1 <br />Identifying Number <br />(c1 <br />Date of <br />Assessment <br />(d) <br />LastDay for <br />mutt <br />fat <br />Unpaid Balance <br />10 <br />6672 <br />6672 <br />6672 <br />******* <br />03/31/2019 <br />06/30/2019 <br />09/30/2019 <br />r*******. **ran*****************,t** <br />XXX-XX-5054 <br />XXX-XX-5054 <br />XXX-XX-5054 <br />04/05/2021 <br />04/05/2021 <br />04/05/2021 <br />tit************** <br />05/05/2031 <br />05/05/2031 <br />05/05/2031 <br />1096.96 <br />10827.93 <br />5828.79 <br />**************** <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802-1692 <br />$ 17753.68 <br />This notice was prepared and signed' at CHTCAGO, IL , on this, <br />the <br />24th day of January , 2025, <br />Signature <br />Title <br />Operations Manager, <br />Centralized Lien Operation <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. Rut. 71-466, 1971 - 2 C.B. 4091 Form 66a (Z) (Rev. 10-2000) <br />Part 1 - RECORDING OFFICE CAT. NO 800281 <br />