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08/27/2012 MON 15:22 FAX 402 471 4429 UCC SECRETARY OF STATE �~~ 9a11 <br />�003/004 <br />Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service � o � 2 o r� ��f � <br />�RB� February 2004) � Notice of Federal Tax Lien �' <br />Area: Serial Number <br />sr�,r� sUSU�ss/srzr �r,o�n �, #4 <br />Lien Unit Phone: (800) 913-6050 888471212 <br />As provided by section 6321, 6322, and 6323 of t6e Internal Revenue <br />Gale, we are givb�g a notice that taues (including interest and penat�ies) <br />have been assessed against the followtng-named taxpayer. We have made <br />a demand for paymeet of tluls liab�ity, but it remains unpaid. Therefore, <br />there is a lien in favor of the United States on aU property and rights to <br />property beionging to this taxpayer for the amount of these taxes, and <br />additiona! penalties, interest, and costx that may accrue. <br />Name of Taxpayer RONALD KING <br />Residence 2615 W CHARLES ST <br />GRAND ISI�AND, NE 68803-5702 <br />For' <br />I. <br />t <br />�� <br />i <br />I` <br />tlnpaid Balance !, <br />of Assessment ! <br />(� ': <br />1724.94 � <br />IMPORTANT RELEASE INFORMATION For each essessment listed below, <br />unless notice of the lien is refiled by the date given in column (e1, this notice shall, <br />on the day following such date, operate as a cerifficate of release as defined <br />in IRC 8325(a). <br />T� Period Date of Last Da foe <br />Kind of Tax Ending Identifying Number Assessment Refii�ng <br />1040 �12/31/2009� XXX-XX-7944 �07/16/2012� 08/15/2022 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand�Island, NE 68802-1692 <br />Total � $ 1724 . 94 <br />This notice was prepared and signed at CHICAGO, IL <br />the 16th day of August 2012 <br />Use bv Recordina Office <br />, on this, <br />Signature /� C �� <br />� � <br />for DANIELLE L MUELLER <br />Title <br />REVENUE OFFICFR 24-10-1720 <br />, (402) 473-4675 x2912 <br />(NOTE: CeRificate of officer authorized by law to take acknowledgmant is not essential to the Jalidity of Notice of Federal Tax lien ? <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) <br />Part 1- Kept By Recording O�ice Form 668(ln(c) IRev. 2-2004) : <br />CA7. NO 60025X <br />