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03/02/2012 FR= 14:52 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br />o�a� 66e mc�� <br />IRev. February 2004) <br />�002/002 <br />Department of the Treasury - Internal Revenue Service � <br />Notice of �ederal T�x Ljen � 012 0�. 6 d(� <br />Area: Serial Number <br />3MALL BII3INESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 850662312. <br />As provided by section 6321, 6322, and 6323 of the Internal itevenue <br />Code, we are givieg a notice that tazes (including interest and penalties) <br />have been assessed against the following�named taxpayer. We have made <br />a demand for payment of this liability, 6ut it remains unpaid. Therefore, <br />there is a lien in favor of the llnired States on all proper¢y and r9ghts to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additiona[ penalties, interest, and costs that may accrue. <br />Residence - 2639 SAINT PATRICK AVE <br />GRAND ISLAND, NE 68803 <br />For Optional Use by Recording Office <br />IMPORTANT RELEASE IN�ORMA770N: For each assessme� listed below, <br />unless notice of the lien is �efiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as a certificate of release as defined � <br />in IRC 6325(a). - <br />Tax Period � Date of Last Day for <br />Kind of Tax Ending [dentiiying Number Assessmede Refil'mg <br />1040 12/31/2009 XXX-XX-8386 06/14/2010 �07/14/2020 <br />1040 12/31/2010 XXX-XX-8386 05/30/2011 06/29/2021 <br />Unpaid �alance <br />of Assessment <br />7329.89 <br />179Z9.79 <br />d <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Is3.and, NE 68802-1692 <br />Total �$ 25249.68 i <br />This notice was prepared and signed at CHICAGO, IL <br />the 21st day of February 2012 <br />, on this, <br />Signatur� Title <br />��` ACS SBSE 24-00-0008 <br />for MICHAEL W. COX (800) 829-3903 <br />(NOTE: Certificate of officer authorized by law to take acknuwledgment is not ossential to the validity of Notice of Federal Tex lien <br />Rev. Rul. 71-486, 1971 - 2 C.B. 409) Form 6S8(Y)(c) IRev. 2-2004) / <br />Part 1- K�t Bjr Recording Office CAT. NA 60025X '�/ <br />