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03/26/2013 TUE 15:04 FAX 402 471 4429 UCC SECRETARY OF STATE <br />ce) <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />14845 <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 -6050 <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving 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 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 />Name of Taxpayer ESTELLA F ADRIAN <br />Residence <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien 201302376 <br />Serial Number <br />1115 W ANNA ST <br />GRAND ISLAND, NE 68801 -6602 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the Hen 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 />Kind of Tax <br />(a) <br />1040 <br />1040 <br />1040 <br />Place of Filing <br />Tax Period <br />Ending <br />(b) <br />12/31/2006 <br />12/31/2007 <br />12/31/2009 <br />the 06th day of March <br />Identifying Number <br />(c) <br />XXX -XX -8643 <br />XXX -XX -8643 <br />XXX -XX -8643 <br />2013 <br />Date of <br />Assessment <br />(d) <br />10/22/2012 <br />10/22/2012 <br />10/22/2012 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />926077813 <br />Hall <br />Last Day for <br />R4fsliing <br />(e) <br />11/21/2022 <br />1101/2022 <br />11/1/2022 <br />For Optional Use by Recording Office <br />NE Sec of Siete John A <br />Gal <br />9913711523 -2 <br />ADRIAN ESTELLA F <br />Filed: 03/26/2013 19:55 AM <br />- UCC FTL <br />Pgs: 1 <br />Unpaid Balance <br />of Assessment <br />{f) <br />"31555.77 <br />144456.83 <br />79210.71 <br />Total $ 255223.31 <br />This notice was prepared and signed at CHICAGO, I L , on this, <br />Signature .. Title <br />REVENUE OFFI!FR <br />for PATRICK J KELLOGG (308) 384 -4050 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential t o he validity of Notice of Federal Tax lien <br />Rev. ev. u . 71-466, 1971 - 2 C.B. 409) <br />Part 1 • Kept By Recording Office <br />24 -10 -1744 <br />Form 668(Y)(c) (Rev. 2 -2004) <br />CAT. NO 60025X <br />0100 /007 <br />