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Q9/12/2012 WED 15:49 FAX 402 471 4429 UCC SECRETARY OF STATE �-�� 8a11 <br />�� <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Department of the Treasury - Internal Revenue Service 2 0� 2 0'7 6 2 S <br />Notice of Federal Tax Lien <br />Area: Serial Number <br />WAGE & INVFsSTMENT .AREA #2 <br />Lien Unit Phone: (800) 829-7650 890925612 <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that taxes (includrng iaterest and penalties) <br />have 6een assessed against the followieg�named taxpayer. We have made <br />a demand for payment of this Gab�ity, but it remains unpaid. Therefore, <br />there is a lien m favor of t6e tJnited Stat�s on aU property and rights to <br />progerr�tyy belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Residence 421 E 6TH ST 2 <br />GRAND ISLAND, NE 68801-4556 <br />For <br />�ooz/003 <br />Office <br />NB See of S�a�e Jahn A 6ele - UCC FTL <br />9912699178-0 Pgs: 1 <br />SfiNT05 ALVARRDO JUpH R <br />Flled: 09/12l2012 03:07 PM <br />[MPORTANT RELF.ASE INEORMATION: 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 following such date, ope�ate as a certificate of release as defined <br />in IRC 6325(a►. <br />Tax Period Date of Last D�ay for <br />1Cind of Tax Ending Identitying Nmnber Assessment Refi16�g <br />1040 <br />1040 <br />1040 <br />1040 <br />1040 <br />1040 <br />1040 <br />Place of Filing <br />12/31/2004 <br />12/31/2005 <br />12/31/2006 <br />12/31/2007 <br />12/31/2008 <br />12/31/2009 <br />12/31/2009 <br />XXX-XX-8067 <br />X�QC-XX-8067 <br />xxx-XX-8067 <br />XXX-XX-8067 <br />XXX-XX-8467 <br />XXX-XX-8067 <br />XXX-XX-8067 <br />03/21/2011 <br />05/02/2011 <br />05/02/2011 <br />05/02/2011 <br />05/02/2011 <br />04/15/2010 <br />07/25/2011 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Isl and, NE 68802-1692 <br />Unpaid Balance <br />uf Auessment <br />4433.25 <br />2656.75 <br />2895.11 <br />2832.23 <br />2838.59 <br />3546.84 <br />Total �$ 19202.77 <br />This. notice was prep�red and signed at <br />the 29th day of August <br />2012 <br />CHICAGO, IL <br />, on this, <br />Signature � �� <br />� 1 <br />for PAMELA J ROGERS <br />Title <br />ACS W&I <br />(800) 829-7650 <br />14-00-0000 <br />04/20/2021 <br />06/O1/2021 <br />06/O1/2021 <br />06/O1/2021 <br />46/01/2021 <br />05/15/2020 <br />08/24/2021 <br />% <br />� <br />� <br />(NOTE: Certificate of officer authorized by lew to take acknowfedgment is not esseniial to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1979 - 2 C.B. 4U91 <br />Part i- Kept By Recordiag Office Form 668(l�(c) IRev. 2-2004) <br />CAT. NO 60025X <br />