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03/09/2011 WED 14:15 FAX 402 471 4429 UCC SECRSTARY OF STATE ��� Hall <br />--*-- <br />Eorm 668 (Z) <br />�Re�. �a2000� <br />2011, <br />Hrea: Seriai Number <br />SMALL BUSINESS/SELF EMPLOYED ARTA #4 <br />Lien Unit Phone: (800) 913-6050 558074709 <br />I certify that the following-named taxpayer, under the requi�ements of section 8325 (a) <br />of the Internal Revenue Code has satisfied the taxes listed helow 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 reve�ue tax lien was filed on July 01 , <br />2 0 0 9 , is authorized to note the books to show the release of this lien for ' <br />these taxes and additions. ' <br />i <br />Name of Taxpayer . <br />CARLOS ORELLANA <br />109/2011 12:18 PM <br />2011018�'� <br />Residence 3 04 S VINE ST <br />GR.AND ISLAND, NE 68801-7819 <br />C:o CORDING INFORMATION: <br />Liber Page C No. Serial No. <br />n/a .n/ 9909601048- 200905364 <br />Kind of Tax � Ending <br />Date of Last Day for llnpaid Balance <br />Assessment Refiling of Asseument <br />1040 12/31/2004 XXX-XX-6896 04/13/2009 05/13/2019 199.68 <br />1040 12/31/2005 XXX-XX-6896 05/11/2009 06/10/2019 4218.26 <br />1040 12/31/2007 XXX-XX-6896 06/O1/2009 07/O1/2019. 5001.54 <br />******** ********** ************* ********** ************ **************** <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Gran Island, NE 68 802-1692 <br />Total �$ 9419 . 4 8 <br />This notice was p�epared and signed at <br />the 23rd day of _ February <br />Signature <br />3592 Department of the Treasury - Internat Revenue Service <br />� Certif cate o� Release of Federal T�x �e� <br />CHICAGO, IL <br />�004/004 <br />, on this, <br />Title Director, Campus Compliance <br />Operations <br />(NVTE: Certificate of officer euthorized by law to take acknowledgments is not essential to the validity of Certificate of Release of <br />. Federal Tax lien Rev. Rul. 71-A66, 1971 - 2 C.B. 409) Form 668 (Z) (Rev. 10-2000) <br />Part t- RECORDING OFFlCE CAT. NO 600261 <br />