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05/29/2012 TUE 14:52 FAX 4Q2 471 4429 UCC 5ECR8TARY OF STATS �+-�y Hall <br />0� <br />Form d68 (n(c) <br />(Rev. February 2004) <br />�002/006 <br />Department of the Treasury - Internal Revenue Service <br />Notice � of Federal Tax I.ien 2 012 U 4 2 5 9 <br />Hrea: Serial Number <br />WAG£ & INVESTMENT AREA #2 <br />Lien Unit Phone: (S00) 829-7650 868411412 <br />As provided 6y section 6321, 6322, and 6323 of the lnternal Revenue <br />Code, we are giving a notice that taxes (includtu�g tnterest and penalties) <br />have been auessed against the following named taxpayer. We ha�e made <br />a demand for payment of this Gability, but it remains unpaid. Therefore, <br />there is a lien m favor of the United States on all property and righ� to <br />property belonging to this taxpayer for the amount of t6ese taxes, and <br />additiona! penatties, wterest, and costs that may accrue. <br />Name of Taxpayer NANCY R CLARK <br />Residence 2303 W� CAPITAL AVE APT 3 <br />GRAIJA ISLAATD, NE 68803-2005 <br />IMPORTANT ltELFASE 1NFORMA710N For each assessment listed betow, <br />unless notice of the lien is refiled by the date given in co�umn (e1, this notice shall, <br />on the day following such date, operate as a cert'rficate of release as defined <br />in IRC 6325(a). <br />For Ootional Use <br />Taac Period Date of Last Day for <br />Kind of Tax Endiag Identify�ing Number Auessment Reflling <br />1040 12/31/20U7 XXX-XX-4862 Ol/09/2012 02/OS/2022 <br />1040 7.2/31/2008 XXX-XX-4862 01/09/2012 02/08/2022 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total � $ <br />7221.49, <br />109.71 <br />7331.20 <br />This notice was prepared and signed at <br />the 16th day of May <br />CHICAGO, IL <br />2 012 <br />, on this, <br />Signature � �� <br />� � <br />for PAM ELA J ROaERS <br />Title <br />ACS W&I <br />(S00) 829-?650 <br />14-00-0000 <br />. <br />(NOTE: CertiBcate of off7cer authorized by law to take acknowledgment is not esserKiai to the validiN of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) � <br />Part 1- Kept By Recording Office �orm 668(Y)(t) IRev. 2-2004) <br />CAT. NO 60025X <br />llnpaid Ba[ante <br />of Auessment <br />� <br />� <br />i <br />i <br />