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Sep. 6. 2013 2:02PM NE Secretary of State — UCC No. 0786 P. 2/6 <br />Foram 668 (Y)(c) <br />(Ray. February 2004) <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829 -3903 <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 Tien 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 KIRK R & ROBIN R BACKUS <br />Residence <br />Kind of Tax <br />(a) <br />1040 <br />Place of Filing <br />3595 <br />This notice was prepared and signed at <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Serial Number <br />4310 MARIAN RD <br />GRAND ISLAND, NE 68803 -1408 <br />IIMPORTA}IT 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 />Tax Period <br />Ending <br />(b) <br />12/31/2011 <br />Identifying Number <br />(c) <br />XXX -XX -0288 <br />the 15th day of August 2013 <br />Date of <br />Assessment <br />(d) <br />10/29/2012 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />Part 1 - Kept By Recording Office <br />955767113 <br />Last Day for <br />Reffilg <br />(e) <br />11/28/2022 <br />201307204 <br />For Optional Use by Recording Office <br />ME Soo of S**ie Jahn A Gale - UCC Ftl. <br />(f) <br />9913722226 -5 Pgs : 1 <br />BACKUS KIRK R <br />Filed: 09/06/2013 01:30 Pal <br />Unpaid Balance <br />of Assessment <br />37908.69 <br />Total $ 37908.69 <br />CHICAGO, IL , on this, <br />Signature / --`•v -•� ACS SBSE 24 -00 -0008 r <br />for G.J.CARTER -LOUIS (800) 829 -3903 <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. 71-4.66, 1971 - 2 C.B. 409) <br />Form 668(Y)(c) (Rev. 2 -2004) \''. <br />CAT. NO 60025X <br />