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11/08/2012 �HU 15:21 FAX 402 471 4429 UCC SSCRETARY OF STATB ~~~ Hall <br />b� - - - <br />Form 668 (Y)(c) <br />(Rev. February �0041 <br />I�003/003 <br />Department of the Treasury - Interna( Revenue Service <br />1Votice of Federa! Tax Lien <br />Area: Serial Number � <br />SMALL BII�INESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 902343812 <br />As provided by section 632t, 6322, and 6323 af the Internal Revenue <br />Code, we are giving a nodce that taxes (includiag interest and penalt�es) ' <br />6ave 6een assessed agaiast the following-named taxpayer. We have made <br />a deroand for payrment of this IiabilitX, but �t remains unpaid. Therefore, <br />there is a lien in favor of the llnited Swt�s an all property and rights to <br />property '�belonging to this taupayer for the amount of these taxes, and <br />addi penatties, interest, and costs that may accrue. <br />Name of Taxpayer <br />Residence I 2222 BELLWOOD DR APT 30 <br />GRAND ISLAND, NE 68801-8282 <br />R Qa16 - UCC FTL <br />Pes: 1 <br />HAMMER ROLLANO D <br />Filed: 19/08/2012 iD:41 AM <br />IMPOR�'A1dT R�LEASE IN�ORMA770N For each assessment listed below, <br />unless notica of ihe lien is refiled by the date given in column (e), this notice shall, <br />on the day foliowing such date, operate as a certificate of release es defined <br />in IRC 6325(a). <br />Tax Period Date of Last Da�y for <br />Kind of Ta�c Ending IdentFfyiu�g Number Assessment Refil�n8 <br />940 12/31/2009 33-1D17606 06/28/2010 07/28/2020 <br />CI�TP 12f31/2008 33-1017606 01/02/2012 02/01/2022 <br />Place of Filing <br />llnpaid Balance <br />of /lssessment <br />3Q1.69 <br />28027.20 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />For Optional Usa by Recording OKlce <br />Tatal {$ 28328.89 <br />This notice was prepared and signed at � IL <br />the 2�th day of October 2012 <br />, <br />, on this, <br />Sfgnature /��� AC3 SBSE 24-00-0008 <br />� � <br />for G.J. CARTER-L�UIS (800) 829-3903 <br />(NOTE: �Cectificate of off{cer authorized by law to take acknowledgment is not essential to the valid'+ty of Notice ot Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 4091 Form 668(n(t) (Rev. 2-2Q04) <br />Parc 1- Kept By Recording OHice CAT. NO 60025X <br />i <br />\V i <br />