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06/18/2012 MON 15:11 F�,X 402 471 4429 UCC SECRSTARY OF STATE -��� Hall <br />Form 668 (1�(c) . <br />(Rev. Februery 2004) <br />Department of the Treasury - Internal Reyenus Service <br />Notice of Federal Tax Lien 2 012 0 4 9 0 G <br />Area: Serial Number <br />WAGE & INVE3TMENT ARF�, #2 <br />Lien Unit Phone: (800) 629-7650 872879112 <br />As provided 6y section b3Z 1, 632Z, and b323 of the Internal Reveeue <br />Cade, we are givBng a nodce that taxes (btcluding interest and pena{ties) <br />have 6een assessed against tl�e following-named taxpayer. We, have made <br />a demand for payment of this liab➢Mity, but it remains unpaid. Therefore, <br />there is a lien n� favor oF the tlnited States on all property and rights to <br />property belonging to tiiis taxpayer for the an�aunt of these taxes, and <br />additioriat penalties, interest, and costs that may accrue. <br />Residence 114 N EDDY ST <br />GRAND ISLAND, NE 68801-5845 <br />For <br />IMPORTANT RELEAS� INFORMATION: 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 tolFowing such date, operate as a certificate of releas� as defined <br />in IRC 6325(a). <br />Tax Period Date oF Las�t D�ay for <br />Kind of Tax Ending Identifying Namber Auessment Refiling <br />1040 12/31/2006 XXX-XX-4853 11/02/2009 12/02/2019 <br />1040 12/31/2007 XXX-XX-4853 08/30/2010 09/29/2020 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 688Q2-1692 <br />6644.99 . <br />11527.48' <br />Total I$ 18172.47 <br />This notice was prepared and signed at <br />the 06th day of June 2012 <br />Signature � C �� <br />� � <br />tor PAMELA J ROGERS <br />CHICAGO, IL <br />�J002/004 <br />� p Gale - UCC FTL <br />Pgs: 1 <br />2 09:20 RM <br />llnpaid Balance <br />of Assessme� <br />,� on this, <br />Title <br />ACS W&I <br />(800) 829-7�650 <br />14-00-0000� <br />(N07'E: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lisn . <br />Rev. Rul. 71-466, 197i - 2 C.B. 409) � Form 668('�(c) (Rav. 2-2004) <br />Part 1 Kept By Recording Office CAT. NO 60025X <br />� <br />i <br />E <br />! <br />f� <br />