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i` <br />4' <br />02/24/2005 17:49 FAX 14024714429 <br />NEBRASKA UCC <br />- - * - - <br />1872 Department of the Treasury Internal RevE <br />Form 668 (Z) Certificate of Release of Federal <br />(Rev- 10 -2000) <br />Area: Serial Number <br />WAGE & INVESTMENT AREA #5 <br />Lien Unit Phone: (651) 312 -8080 3902S3194 <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 February 13 <br />2002 , is authorized to note the books to show the release of this lien for <br />theca tnYnc and wiriitinns- <br />Name of Taxpayer <br />LENIS B RIVERA <br />ICJ 003/005 <br />200501565 <br />ue Service <br />Tax Lien <br />For Use I <br />irding Uttice <br />roo <br />i <br />i <br />52 PM <br />Residence 617 E YUND <br />GRAND ISLAND, NE 68801 -7759 <br />COURT <br />RECORDING INFORMATION: <br />Liber Page U E--- Serial No. <br />n/a n/a 9902195280 -7 J'200201741 <br />Tax Period <br />J <br />Date of <br />East <br />Dayy for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refffing <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(eJ <br />(fJ <br />1040 <br />12/31/1995 <br />625 -12 -7430 <br />03/08/1999 <br />04/D7/2009 <br />3079.03 <br />1040 <br />12/31/1996 <br />625 -12 -7430 <br />03/08/1999 <br />04/D7/2009 <br />3051.33 <br />1040 <br />12/31/1997 <br />625 -12 -7430 <br />03/08/19 -99 <br />04/ <br />7/2009 <br />2505.70 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 16th day of February <br />Signature <br />2005 <br />Omaha, NE <br />Total 1$ <br />8636.06 <br />, on this, <br />Title Directo:', Payment Compliance <br />(MOTE: Certificate of officer authorized by -law to take acknowledgments is not <br />— , __, T_. ­— o..., n„i 71 _ARR 1 q71 - 2 C.B. 409) <br />to the validity of Certificate of Release of <br />Form 668 (Z) (Rev. 10 -2000) <br />F <br />r <br />W 13 <br />