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05/09/2012 wED 14:33 FAX 402 471 4429 UCC SECRETARY OF STATE y�y Hall <br />Fonm 668 (ln(c) <br />(Rev. February 2004) <br />Department of the Treasury - Internal Revenue Service , <br />Notice of Federai Tax Lien 2 012 0 3 7 9 <br />Area: Serial Number For Optionel Use by Recording Of(ice <br />SMAI,L BIISINESS/SELF EMPLOYLD AREA #4 <br />Lien Unit Phone: (800) 913-6050 864266212 <br />As provide�d 6y section 6321, 6322, aad 6323 of the lnternal Revenue <br />Code, we are giving a notice that taxes (including interest and penalties) <br />have been assessed agalnst the follow�g-named taxpayer. We have made <br />a demand for payment of this I�ability, 6ut it 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 taxpayer for the amount of these taxes, and <br />additionaI penalti�, interest, and costs that may accrve. <br />Name of Taxpayer <br />Residence 3412 S COTTONWOOD RD <br />KFARI�TEY, NE 68845-0608 <br />NE sae eF state JeF�n q Gele - ucc FTL <br />9912691632-6 P9s: � <br />DE L05 NNGELES REYNRLDO <br />Filed: 05l09/2012 10:32 AM <br />�OQ2/003 <br />1MPORTANT 1LELEASE 11NFORMATION: 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 IRC 6325(a). <br />Tax Period Date of Last Day for <br />Kind of Tax Ending ldentifying Namber Assessment Refll'mg <br />6672 12/31/2009 XXX-XX-3416 08/15/2011 09/14/2021 <br />6672 03/31/2010 XXX-XX-3416 08/15/2U11 09/14/2021 <br />6672 06/30/2010 XXX-XX-3416 08/15/2011 09/14/2021 <br />6672 09/30/2010 XXX-XX-3416 08/15/2011 09/14/2021 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Unpaid Balance <br />of Assessment <br />14017.51 <br />16731.72 <br />18165.04 <br />11111.57 <br />Total �$ 60025.84 <br />This notice was prepared and signed at <br />CHICAGO, IL <br />the 26th day of April 2012 <br />, <br />, on this, <br />Signature Title <br />���C�v� REVENUE OFFICTsR 24-10-1732 <br />for CAROL HALL (402) 473-4673 <br />(NOTE: Certificate of officer authorized by law to take acknowfedgment is not essential to the validity of Notice of Federel Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004) <br />Part 1- Kept By Resording Offlce CAT. NO 6002bX <br />.\ <br />� <br />