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06/11/2013 TUE 14:09 FAX 402 471 4429 UCC SECRETARY OF STATE <br />i <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br />Residence <br />12832 <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 -6050 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Serial Number <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 JERRY TYNAN AGENCY INC, a Corporation <br />3614 BRONCO RD <br />GRAND ISLAND, NE 68801 -8660 <br />IMPORTANT RELEASE INFORMATION: 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, operate as a certificate of release as defined <br />in !RC 6325(a). <br />Kind of Tax <br />(a) <br />941 <br />Place of Filing <br />Signature <br />Tax Period <br />Ending <br />(b) <br />12/31/2012 <br />This notice was prepared and signed at <br />the 03rd day of June 2013 <br />for PATRICK J KELLOGG <br />Identifying Number <br />(c) <br />26 2365844 <br />Date of <br />Assessment <br />(d) <br />05/20/2013 <br />Register of Deeds <br />Hall POBOX.1692 <br />Grand Island, NE 68802 -1692 <br />a y y <br />942647613 <br />Last Day for <br />Refiling <br />(e) <br />06/19/2023 <br />Title <br />REVENUE OFFICER <br />(308) 384 -4850 <br />Hall <br />L01304624 <br />For Optional Use by Recording Office <br />NE See of SkaAe John A Gale - UCC FTL <br />9913716747 -1 Pgs: 1 <br />JERRY TYNAN AGENCY R CORP <br />Total $ <br />Unpaid Balance <br />of Assessment <br />(f) <br />1619.12 <br />J003/003 <br />1619.12 <br />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. Rul. 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 />