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03/08/2012 T8U 14:33 FAX 402 471 4429 UCC SECRBTARY OF STATB �y� 8a11 <br />For Optional Use by Recording Offica <br />0 <br />Form 668 (Y)(c) <br />(Rav. February 2004) <br />Department of the Treasury - Internal Revenue Service . <br />Notice of Federai 7'a�c �,i�n � � 12 0�. 819 <br />Area: Serial Number <br />SMALL BIISINES3/SELF BMPLOYED ARTA #4 <br />Lien Unit Phone: (800) 913-6050 850895112 <br />As provided by section 6321, 6322, an� 6323 of the Internal Revenue <br />Code, we are �g a notice ehat taxes (including interest and penalties) <br />have been assessed against the following-named taxpayer. We have made <br />a demand for payment of this I�ability, but it remains unpaid. Therefore, <br />there is a lien in favor of the dlnited States on all property and rights to <br />property belonging w this taxpayer for the amount of these taxes, �r�9 <br />add�tional penalties, interest, and wsts that may accrue. <br />Residence 1203 SYLVAN ST <br />GRAND ISLAND, NE 68801 <br />IMPORTANT RELBASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this �otice 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 D�a� tor <br />Kind of Tax End'mg ident�g Number Assessment l�fi{mg <br />66 72 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />Place of Filing <br />03/31/2009 <br />06/30/2009 <br />09/30/2009 <br />12/31�2009 <br />03/31/2010 <br />06/30/2010 <br />09/30/20].0 <br />03/31/2011 <br />XXX--XX-1860 <br />XXX-XX-1860 <br />XXX-XX-1860 <br />XXX-XX-1860 <br />XXX-XX-1860 <br />XXX-XX-1860 <br />XXX-XX-1860 <br />XXX-XX-1860 <br />O1/02/2012 <br />O1/02/2012 <br />O1/02/2012 <br />Ol/02/2012 <br />O1/02/2012 <br />O1/02/2012 <br />01/02/2�12 <br />O1/02/2012 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 688U2-1692 <br />[dj002/005 <br />I �� w �e�e - ucc vr� <br />p9s: 1 <br />12 11:27 Rpl <br />�np�aid �alane� <br />o� Asssssm�nt <br />265G.."s0 <br />6307.31 <br />4406.76 <br />3808.87 <br />337a.57 <br />3546.58 <br />3586.5a <br />3046.'79 <br />Total �$ 3 0 72 7. 6 8 <br />This notice was prepared and signed at <br />the 22nd day of February <br />CHICAGO, IL <br />2012 <br />, on this, <br />Signature Title <br />�� REVENUE 0�':'ICER 24-10-1%39 `�: <br />tor KAY PONTE (308) 3E4-48S0 <br />.� <br />(NOTE: Certificate of officer authorized by law to teke acknowledgment is not essential to th� vslidity of Notice o� Federal Tax li�n �� <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) 1Rev. 2•2004; <br />Part 1- Kept By Retor�ieg Office . �Ai'. NO 60C?�;<. <br />02/Ol/2022 <br />02/01/2022 <br />02/O1/2022 <br />02/01/2022 <br />02/01/2022 <br />02/01/2022 <br />02/01/2022 <br />02/01/2022 <br />