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12/28/2Q11 W8D 15:11 <br />V� �orm 668 (Y)(c) <br />IRev. Pebruery 2004) <br />20i14��64 <br />NE See of Sfefa John p 6ale - ��� pT <br />Department of the Treasury - Inte�nal Revenue Se <br />Notice of Federa! Tax Lien <br />Area: Serial Number For ( <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 99116805sa_a <br />Lieh Unit Phone: (800) 913-6050 836448211 -- ' <br />As provided by section b32 t, 6322, and 6323 of the Intenwl Revenue <br />Code, we are giving a notice that taxes (including interest and pEealties) <br />have been asseued against the following-�med taxpayer. We have made <br />a demand for payment of this {iabiliry, but it remains unpaid. Therefore, <br />there is a lien in favor of the lle�ited States on all property and righu to <br />propeny belonging to this taxpayer for the amount of these taxes, and <br />additiona! penalties, interest, and casts that may aczrue. <br />of Taxpaye� <br />FAX 402 471 4429 UCC SECRETARY OF STATE -��-� 8a11 �002/Q04 <br />Residence 2421 LAMAR AVE <br />GR.AND ISLAND, NE 68803 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in aolumn (e), ihis notice shall, <br />on the day following such date, opeiate as a certificate of release as deflned <br />in IRC 632b(a1. <br />Kind of.Tan <br />(a) <br />8278 <br />8278 <br />8278 <br />8278 <br />8278 <br />8278 <br />Placa of Filing <br />XXX-XX-4873 <br />XXX-XX-4873 <br />XXX-XX-4873 <br />XXX-XX-4873 <br />XXX-XX-4873 <br />XXX-XX-4873 <br />07/20/2009 <br />07/20/�009 <br />07/20/2Q09 <br />07/20/2009 <br />07/20/2009 <br />07/20/2009 <br />Register of Deeds <br />�Iall POBOX 1692 <br />Grand Island, NE 68802- <br />08/19/2019 <br />06/19/2019 <br />08/19/2019 <br />OS/19/2019 <br />08/19/2019 <br />08/19/2019 <br />0 <br />This notice was prepared and signed at CHICAGO, IL <br />the 14th day of December 2011 <br />. • <br />, on this, <br />Signature • � . - � �Title . . • . � <br />. ACS SB�E �24-OQ-0008 <br />for MICHAEL�•W. COX (800) 829-3903• � � � <br />. (NOTE: Certificata of officer autho�zed by law to taka acknowledeme�t is not essant�al to the validiiy of Nodae of Federaf Tax lien • • .' <br />Rev. Rul. 71-466, 1971 - 2 E.B. 409) � • . ' Form 668(�(c) IRev. 2-20041 ��J /• <br />. .. Pa[t f• K�Y BY ltetordteg �Hi[e • rnT nin ann��v �I� <br />Tax Period I � Date of I I.ast Day for <br />Ending Identifying Number Assessment Refiling <br />06/3U/2005 <br />09/30/2005 <br />12/31/2005 <br />03/31/2007 <br />06/30/2007 <br />12/31/2007 <br />l <br />70:38 p1+1 <br />Unpaid �alante <br />of Assessmeat .' <br />(� <br />581.66 <br />2707.47 <br />3113.82 � <br />336.98 � <br />395.45 <br />1665.53 � <br />Total �$ 8800.91 <br />