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04/12/2012 THU 15:15 FAX 402 471 4429 UCC SECRETARY OF STATE �-�-� Hall <br />0� Form 668 (Y)(c) <br />(Rev. Fe6ruary 2004) <br />119 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien � a 12 0 2� 7� <br />Hrea: Serial Number <br />WAGE & INVFsSTMENT AREA #2 <br />Lien Unit Phone: (800) 829-7650 858916712 <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Gode, we are grving a notice that taxes (mcluding interest and penalties) <br />have been assessed against the follo�idg-named taxpayer. We have made <br />a demand for payment of th�s liability, but it remai»s unpaid. Therefore, <br />there is a lien in favor of the tlnited States on aU property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penakies, interest, and cosu that may accrue. <br />Name of Taxpayer LUIS ANDAZOLP, <br />Residence 2323 BELLWOOD DR <br />, GRAND ISLAND, NE 68801-8205 <br />Office <br />IMPORTANT RELEASE MFORMAT[ON: For each assessment iisted below, <br />unless notice of the lien is refiled by the date given in column (e)., th(s notice shall, <br />� on the d'ay following such date, operate as a certificate of release as defined <br />in IRC 6325 (a). <br />Tax Period Date of Last Da�yfor <br />Kind of Tax � Endiag Identifjring Number Assessment Ref6ling <br />1040 12/31/2004 XXX-XX-4740 11/02/2009 1�2/02/2019 <br />1040 12/31/2006 XXX-XX-4740 11/02/2009 12/02/2019 <br />1040 12/31/2007 XXX-XX-4740 08/30/2014 09/29/2020 <br />Place of Filing <br />linpaid Balance <br />of As�tessment <br />6240.50 <br />4513.57 <br />5357.45 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Isla nd, NE 68802-1692 <br />Total I $ 16111. 52 <br />This notice was prepared and signed at <br />the 03rd �ay of April <br />CHICAGO, IL <br />2012 <br />Signature /"�� �� <br />� � <br />for PAMELA J ROGERS <br />, on this, <br />Title <br />ACS W&I <br />(8 00) 829-7650 <br />14-00-0000 <br />�003/003 <br />(NOTE: Certificate of officer authorized by lew to take acknowledgment is not essentiaf to the validity of Notice of Federal Tax lien i.• <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(n(c) (Rev. 2-2004) i <br />PaR 1- Kept By R�ording Offlce CAT. NO 60025X �� /;` <br />• - • - � • .. . . _.. v � • <br />