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Form 668 (Y)(c) <br />(Rev. February 2004) <br />3595 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BIISINESS /SELF EMPLOYED AREA # <br />Lien Unit Phone: (800) 913 -6050 <br />Serial Number <br />919174913 <br />For Optional Use by Recording Office <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />20i3 61 <br />Code, we are giving a notice that taxes (including interest and penalties) <br />HE sec °= Slake john <br />have been assessed against the following -named taxpayer. We have made <br />III <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the United States on all property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />991370 -1 Pas: 1 <br />COR <br />Name of Taxpayer FISCHER CONSTRUCTION INC <br />a Corporation <br />• <br />Fi led R <br />Residence 9508 S HWY 11 <br />WOOD RIVER, NE 68883 -9345 <br />RELEASE INFORMATION: For each assessment listed below, <br />I IMPORTANT <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, operate as a certificate of release as defined <br />in IRC 6325(a). <br />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refiring <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />941 <br />09/30/2011 <br />26- 0047293 <br />01/07/2013 <br />02/06/2023 <br />12551.75 <br />941 <br />12/31/2011 <br />26- 0047293 <br />01/14/2013 <br />02/13/2023 <br />12268.07 <br />941 <br />03/31/2012 <br />26- 0047293 <br />01/07/2013 <br />02/06/2023 <br />9361.20 <br />941 <br />06/30/2012 <br />26- 0047293 <br />01/07/2013 <br />02/06/2023 <br />3059.86 <br />941 <br />09/30/2012 <br />26- 0047293 <br />01/14/2013 <br />02/13/2023 <br />13753.54 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 50994.42 <br />Grand Island, NE 68802 -1692 <br />02/05/2013 TUE 14:52 FAX 402 471 4429 UCC SECRETARY OF STATE <br />the <br />29th day of January 2013 <br />Signature /7"..n_ <br />for PATRICK J KELLOGG <br />y y y <br />Title <br />REVENUE OFFICER <br />(308) 384 -4850 <br />Hall <br />This notice was prepared and signed at CHICAGO IL , on this, <br />24 -10 -1744 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rut. 71 -466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2 -2004) <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />21005/005 <br />