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03/22/2012 T8U 14:34 FAx 402 471 4429 UCC SECRETARY OF STATE -�-+-� 8a11 <br />� ,� <br />, <br />�ooz/ooz <br />For�n 668 (Y)(c) <br />(Rev. February 2004) - <br />Area: <br />WAGB & INVESTMENT AREA #2 <br />Seria! Number <br />Lien Unit Phone: (8�00) 829-7650 854769312 <br />As provided by secdon 63Zi, 6322, and 63Z3 of the Internal Revenue <br />Code, we are giving a notice �eat taxes (including interest and penalties) <br />have been ass�sed against the following-named taxpayer. We have made <br />a demand �or payment �f this liab�ity, but it remains unpaid. Therefor�, <br />there �s a lien in Favor of t�e [leited States oe all property and rights to <br />propeny betonging to this taxpayer for the amount of thes� taxes, and �' <br />additional penalties, unterest, and costs that may aarue. . <br />Residence 259 S VINL ST <br />. GRAND•ISLAND, NE 68801-7880 <br />For Oatfonal Use bv Recordiag Office <br />IMPORTANT RELENSE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date,given in column (e), this notice shall, <br />on tha day foliowing such date, operate as a certificete of release as defined <br />in IRC 6325(a). <br />Tax Period Date of Last Day for <br />Kind of Taz EndMg Identifying Number. Assessmenc Ref�ing <br />1040 <br />12/31/2009� XXX�-�IX-3105 �05/31/2010� U6/30/2020 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 <br />tlnpaid Balance <br />of Assessment <br />Total � $ <br />4652.10 <br />4652.10 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 13 th day of March 2 012 <br />� <br />Signature �tc� AC3 W&I 14-00-0000 : <br />for PAMELA J ROGERS (800) 829-7650 <br />(NOTE: Certiflcate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Fedsral Tex lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 4U9) Form 668(n(t) IRev. 2-2004 i <br />Part 1- K�t By Recording 08tce CAT. NO 60025X t ' <br />Department of the Treasury - Internal Revenus Service <br />Not ice of Federal Tax Lien � 0� 2 0 2 2�. 7 <br />