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08/02/2011 TUE 14:35 FAX 402 471 4429 UCC SECRETARY OF STATE �-�y 8a11 <br />--*-- <br />Form� 668 (Z) <br />�Re�. � az000► <br />f�looz/oos <br />3 5 9 2 Department of the Treasury - Internal Revenue Service ',� O 1 1 O 5 7;3 ;3 <br />Certificate of Release of Federal Tax Lien <br />Area: Serial Number <br />SMALL BUSINE3S/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 � 149426403 <br />I certify that the following-named taxpayer, under the'requirements of section 6325 (a) <br />of the Irrternai Revenue Code hes satisfied the taxes listed below and all statutory <br />additions. Therefore, the lien provided by Code seetion 6321 for these taxes and <br />additions has b�en released. The proper officer in the office where the notica of � <br />internaf revenue tax lien was filed on January 07 <br />2 0 04 , is authorized to note the books to show the �elease of this lien for <br />these taxes and additions. <br />Name of Taxpayer <br />ANTONIO DE L•A ROSA <br />Residence 704 P 8TH <br />GRANII ISLAND, NE 68801-2728 <br />COIIR.T RECORDING INFORMATION: <br />Liber Page IICC No. Serial No. <br />2004 00169 9�9903310658-1 2004-00169 � <br />� Tax Period Date of <br />Kind of Tax Ending Identifying lNumber Assessment <br />NE Sae af <br />DE LR <br />Filed: <br />:12 R�P'll <br />GiFTL <br />Last D�ay for I llnpaid Balance <br />RefWng of Asseument <br />104Q 12�/31/2000 XXX-XX-�1930 04/15/2001 05/15/2011 <br />1040 12/31/2U00 XXX-XX-1930 02/03/2003 03/05/2013 6168.91 <br />******,�* ***,r,�***** ��r�r��x�x�****,r* ***��x,��**� �t*********�* **,��r*������r�t�*** <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Gr and Island, NE 68802-1692 <br />Total � $ 6168 . 91 <br />This notice was prepa�ed and signed at CHICAGO, IL <br />the. 20th day of July � 2011 <br />Signature <br />SEE ATTACHMENTS <br />, on this� <br />Titte Director, Campus Compliance <br />Operations <br />(NOTE: Certificate of officer authorized by law ta take acknowledgments is not essential to the validity oi Certificate of Releasa of <br />Federal Tax lien Rev. Rul. 71-466,� 1971 - 2 C.B. 4081 Form 668 (Z) (Rev. 10-2000) <br />Pairt i- ltECORDING OFFICE CAT. NO 600261 <br />�, <br />