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04/10/2012 TUE 15:43 FAX 402 471 4429 UCC SL'CRETARY OF STATE ~~~ Hall <br />o� <br />Form 668 (Y)(c) <br />ffiwv Rwhn�arv 7M1A1 <br />SMALL BUSINESS/S}3LF EMPLOYED AREA #4 <br />lren Unit Phone: (800) 913-6050 857773712 <br />l� provide� by sect�on 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that taxes (including and penalties) <br />have been assessed against the fol[owing-named taxpayer: We have made <br />a demand for payment of this liabilil,y, but ➢t remains unpaid. Therefore, <br />there is a lien in favor of the united States on all property and rights to <br />property belonging to this t�axpayer for the amount of these taxes, and <br />additionaf penaities, interest, and costs that may accnte. <br />Name of Taxpayer ANTONIO J CALDERON COX � <br />IMPORTANT RE4�ASE {N'FORMATION: 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 the day following such date, operate as a certificate of release as defined <br />in fRC e3251a?. <br />Area� Serial Number For Optionel Use by Recording Office <br />Residence � 422 N WALNC�T ST <br />GRAND ISLAND, NE 68801-4516 <br />NE <br />I <br />Tax Period Date of Last Day �for <br />Kind of Tax End�ng ldentifying Number . Assessment RefilinS <br />� a) . (6) (� �(d) (e) <br />1040 12/31/2009 XXX-XX-0512* Ol/02/2012 02/O1/2022 <br />Place of Filing <br />��� <br />Register of Deeds <br />Hall POBQX 1692 <br />Grand Island, NE 68802-1692 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien 2 ��- � 0 2� 1 C <br />�j003/004 <br />9ale . tli <br />P9s: 1 <br />PM <br />Unpaid Balance � :.. <br />of Asseument <br />„ <br />(� <br />3772.72 ' , <br />�_ <br />7otal �$ 3772.72 <br />This notice was prepared and signed at <br />the Zsth day of March <br />Signature �—�f <br />for KAY PONTE <br />CHICAGO, IL <br />2012 <br />, on this, <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br />24-10-1739 <br />(NOTE: Certificate of otficer authorized by law to take ecknowledgment is not essentiaf to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(n(t) (Rev. 2-2004! <br />Part i- Kept By Recording Offlce CAT. NO 6002bX � <br />� <br />i <br />