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07/Z3/20 MON 15:03 FA7L 402 471 4429 UCC SECRETARY OF STATB ��� 8a11 <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br />� <br />�003/003 <br />Department of the Treasury - Intemal Revenue Service <br />Notice of Federai T� Lien <br />Area: Seria! Number <br />SMALL B[7SINESS/'SELF FyMPLOYED AREA #4 <br />Lien Unit Pho�e: (80U) 913-6050 881412612 <br />As provided by secrion 6321, 6322, aed 6323 of the Internal Revenue <br />Code, we are g�ving a notice that taxes (including interest and penalties) <br />have been assessed against the following-named taxpayer. We have made <br />a demand for payment of this liabi�lrty, but it remains unpaid. Therefore, <br />there is a Uen in favor of the llnited States on all property and rights w <br />praperty belonging to this taxpayer for the amoant of these taxes, anc� <br />additwnal penalties, interest, and costs that may aarue. � <br />Fo <br />��1`��4G��� <br />Residence p0 BOX 295 <br />DONIPHAN, NE 68$32-0295 <br />IMPORTAI�IT RELEASE INFORMATIOAI: For each assessment listed befow, <br />unless notice of the lien is refilsd by the date given in column (e), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 63251a). <br />Tax Period Date of Last Day for <br />Kind of T� Ending Identifying Number Assessment Reflling <br />ta) b) �) (d) (e) <br />� 1040 �12/31/2008 XXX-XX-8185 06/18/2012 07/18i2422 <br />1040 12/31/20�09 XXX-XX-8185 06j18/2012 07/18j2022 <br />Place of Filing <br />llnpaid Balance <br />of Assessment <br />10b366.44 <br />?9763.90 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NT 68802-1692 <br />Tota! {$ 18 613 0. 3 4 <br />This notice was prepa�ed and signed at <br />the 13 th day vf July <br />2U12 <br />CHICAGO, IL <br />, on this, <br />Signature Titfe <br />\��C�c9.t� R:EVENUE OFFICER 24-10-1720 <br />for DA�TIELLE L MUELLER (402) 473-4675 x2912 <br />(NOTE: Certificate of officer a�thorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax Ifen <br />Rev. Rul. 71-466, 7971 - 2 C.B. 409) f-orm 668(�(t) iRev. 2-2004) <br />• Part 1- Kepc By Itecording Office CAT, NO 60026X <br />0 <br />� <br />