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06/12/2012 TUE 13:54 FAX 402 471 4429 UCC SECRETARY OF STATE -��y Hall <br />Form 668 (lf)(c) <br />IRev. Fe6ruary 2004) <br />Department of the T�easury - Intetnal Revenue Service <br />I�totice of Federal Tax Lien <br />Area: Serial Number <br />3MALL BIISINESS/SFLF EMPLOYED AREA #1 <br />Lien Unit Phone: (800) 913-6050 872079712 <br />As provided by section d321, 6322, and 6323 of the Internal Revenuo <br />Code, we are �iving a notice that taxes (incIuding interest and penalties) <br />have been assessed against the foQowing named ta�ayer. We have made <br />a demand for payment of this lia6ili�y, but h remains unpaid. Therefore, <br />there is a 6en in favor of the llnited States on all property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />addrtionaI penalties, interest, and wsts that may aarue. � <br />Name of Taxpayer PETER J& SHANE KOSZALKOWSRI <br />Residence 210 C.AMPBELL AVE <br />DONIPHAN, NE 68832-9787 <br />For <br />����d����# <br />IMPORTANT RELEASE IN�ORMATION Far each assessment listed 6elow, <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 e certificate• of release as defined <br />in IRC 6325(a). . <br />Tax Period Date of Last Day �for <br />Kind of Tax Endimg Identifying Number Asseument Refiiing <br />� 1040 12/31/1999 XXX-XX-4854 07/U9/2007 08/08/2017 <br />1040 12/3I/2000 XXX-XX-4854 07/16/2007 OS/15/2017 <br />1040 12/31/2001 XXX-XX-4854 07/30/2007 08/29/2017 <br />1040 12/31/2002 X$X-XX-4854 08/06/2007 09/Q5/2017 <br />Place of Filing <br />�003/006 <br />3913.39 <br />16687.53 <br />7459.63 <br />1117 . 02.. <br />Register of Deeds <br />Hall POBOX 1692 � <br />Grand Island, NE 68802-1692 <br />Total I$ 29177.57 <br />This notice was prepared and signed at <br />the Olst day of June <br />2012 <br />CHICAGO, IL <br />, on this, <br />Signature � �{ <br />� l <br />for KAREN ESPOSITO <br />Title <br />CASE PROC MGR <br />(866 611 -6191 <br />21-00-0018 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essentfal to the validiry of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 6b8(Y)(t) (Rev. 2-20�4) <br />Part 1- Kept By Recordiag Office CAT. NO 60025X <br />0 <br />unpaid Balance <br />of Ass�ssment <br />1V <br />