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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 201305036 <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829 -3903 <br />Serial Number <br />944141313 <br />For Optional Use by Recording Office <br />NE <br />99137173 <br />IRS <br />Filed: <br />Sec of Siaie <br />11 <br />R <br />06 <br />4 <br />/24/2013 <br />John A <br />11111 <br />-2 <br />RD <br />10:63 <br />bale - UCC <br />Pgs: <br />AM <br />FT L <br />1 <br />1 <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 RICHARD & HEATHER SIEMERS <br />Residence 114 E 22ND ST <br />GRAND ISLAND, NE 68801 -2329 <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 IRC 6325(a). <br />Kind of Tax <br />(a) <br />Tax Period <br />Ending <br />(b) <br />Identifying Number <br />(c) <br />Date of <br />Assessment <br />(d) <br />Last Day for <br />Refiling <br />(e) <br />Unpaid Balance <br />of Assessment <br />(f) <br />1040 <br />1040 <br />12/31/2009 <br />12/31/2010 <br />XXX -XX -1698 <br />XXX -XX -1698 <br />02/20/2012 <br />04/15/2013 <br />03/22/2022 <br />05/15/2023 <br />11643.49 <br />74245.21 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802 -1692 <br />$ 85888.70 <br />06/24/2013 MON 15:14 FAX 402 471 4429 UCC SECRETARY OF STATE <br />This notice was prepared and signed at <br />the 11th day of June 2013 <br />Signature <br />for G.J. CARTER -LOUIS <br />..CHICAGO ...._IL ...................... .............. <br />on this, <br />Title <br />ACS SBSE <br />(800) 829 -3903 <br />Hall <br />12003/004 <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) <br />Part 1 - Kept By Recording Office <br />24 - 00 - 0008 <br />Form 668(Y)(c) (Rev. 2 -2004) <br />CAT. NO 60025X <br />