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Form 668 (Y)(c) <br />IRev. February 2004) <br />3595 `- <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Taus; Lien 201306257 <br />Area: • <br />WAGS & INVESTMENT ARRA #2 <br />Lien Unit Phone: (800) 829-7650 <br />Serial Number <br />950354613 <br />For Optional Use by Recording Office <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />NE <br />sec of <br />I +•t. John <br />R o.1■ ; UC 1 <br />Code, we are giving a notice that taxes (including interest and penaides) <br />have been assessed against the following -named taxpayer. We have made <br />1 <br />lilt <br />111111 <br />a demand for payment of this liability, but k 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 />991372 <br />247 -7 <br />Peg : 1 <br />additional penaides, interest, and costs that may accrue. <br />th <br />Fl led: 0 2120 3 Y 111 <br />0e:15 AM <br />Name of Taxpayer DONALD W III & JESSICA K MCCORMICK <br />• <br />Residence 919 E 12TH ST <br />GRAND ISLAND, NE 68801 -2615 <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(x). <br />Kind of Tax <br />Tax Period <br />Number <br />Assessment <br />R�1ing <br />Refl6ng <br />Balance <br />of�Asse�ent <br />(a) <br />(b) <br />d) <br />(0) <br />(1) <br />1040 <br />12/31/2 <br />N N N N N N <br />Lt1 Lf1 L1'1 Ll Lt1 <br />d� d' <br />1 eN d de <br />01 01 01 01 01 01 <br />', 5011 <br />11/14/2005 <br />12/14/2015 <br />1185.72 <br />1040 <br />12/31/2 <br />11/28/2005 <br />12/28/2015 <br />2003.45 <br />1040 <br />12/31/2 <br />12/29/2008 <br />01/28/2019 <br />1540.31 <br />1040 <br />12/31/2 <br />02/23/2009 <br />03/25/2019 <br />7861.85 <br />1040 <br />12/31/2 <br />11/24/2008 <br />12/24/2018 <br />2791.89 <br />1040 <br />12/31/2 <br />04/25/2011 <br />05/25/2021 <br />3856.61 <br />• <br />Place of Filing <br />Register of Deeds • <br />Hall POBOX 1692 Total <br />$ 19239.83 <br />Grand Island, NE 68802-1692 <br />Aug. <br />2013 2:56PM NE Secretary of State — UCC <br />This notice was prepared and signed at CHICAGO, <br />IL , on this, <br />the 18th day of July 2013 <br />Signature <br />for MARY T. DELACRUZ <br />Title <br />ACS W &I <br />(800) 829 -7650 <br />No, 0270 P. 2/3 <br />14 -00 -0000 • <br />(NOM Certificate of officer authorized by law to take acknowledgment Is not essential to the validity of Notice of Federal lax lien <br />Rev. Rul, 71 -488, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2 -2004) <br />• Part 1 - Kept By kooaes Office CAT. NO 80026X <br />• <br />