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v <br />11/30/2004 18:12 FAX 14024714429 NEBRASKA UCC <br />200411571 <br />Form 668 (Z) 1872 Department of the Treasury - Internal Revenue Service <br />(Rev. 10 -2000) Certificate of Release of Federal Tax Lien <br />Area: Serial Number For Use I <br />WAGE & INVESTMENT AREA #5 <br />Lien Unit Phone: (651) 312 -8080 390369682 ►E s.. .r s• <br />I certify that the following -named taxpayer, under the requirements of section 6325 (a) <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 on May 0 6 990436217 <br />2003 , is authorized to note the books to show the release of this lien for Filed: ESC', <br />Filed: 11/', <br />these taxes and additions. <br />Name of Taxpayer <br />JOSE A MADRID ESCALANT <br />IM 004/006 <br />Office <br />Too <br />Pat: I <br />56 PM <br />Residence403 E 2ND <br />GRAND ISLAND, <br />NE 68801 <br />COURT <br />RECORDING INFORMATION: <br />Liber Page UCC.,,_No -. --- • --- --- ---- Serial No. <br />2003 05622:::::2'§03273694-1 00305689 <br />l 'Tax Period - -- <br />�T^ r <br />Kind of Tax <br />Ending <br />Identifying Number <br />Date of <br />Assessment <br />Last Day for <br />Refilling <br />Unpaid Balance <br />of Assessment <br />(a) <br />(bl <br />(Cl <br />(d) <br />(e) <br />(fl <br />1040 <br />12/31/1996 <br />603 -76 -1471' <br />07/16/2001 <br />08/15/2011 <br />8198.98 <br />1040 <br />12/31/1997 <br />603 -76 -1471 <br />07/16/2001 <br />08/15/2011 <br />5651.68 <br />Place of Filing <br />Register of Deeds <br />Hall POPDX 1692 Total $ 13850.66 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at Omaha, NE <br />the 17th day of November , 2004 <br />, on this, <br />Signature Title Director Payment Compliance <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 1 - RECORDING OFFICE CAT. NO 600261 <br />