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Form 668 (Y)(c) <br />(Rev. February 2004) <br />14583 <br />Department of the Treasury - Internal Revenue Service 2 013 0 9 9 6 b <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SEL? EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 - 6050 <br />Serial Number <br />974055913 <br />For Optional Use by Recording Office <br />.Filetl: <br />NE sec <br />I i <br />9913727954- <br />eersctc.riaacv... <br />°' •'. <br />. balm " Bals - LI" `r` <br />IIIIIIII II <br />-3 Pgs: 1 <br />. _ 0 - 6: . _ - - <br />3 nl1 <br />• As provided by section 6321, 6322, and 6323 of the Internal <br />Code, We are giving a notice that taxes (including interest and penalties) <br />have been assessed against the folIowInrnamed We <br />Revenue <br />made <br />to <br />and <br />- -- -.. <br />taxpayer. have <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 <br />property belonging to this taxpayer for the amount of these taxes, <br />additonal penakIes, Interest, and costs that may•accive. - - -.- <br />1212e <br />• - <br />Name of Taxpayer RANDY BROCTK. <br />Residence 623 ROUSH LN <br />GRAND ISLAND, NB 68801 -2209 <br />IMPORTANT <br />unless notice <br />on the day <br />in IBC 6325(e). <br />RELEASE INFORMATION: <br />'of the lien is refiled <br />following such date, <br />For each assessment listed below, <br />by the date given in column (e), this notice shall, <br />operate as a certificate of release as defined <br />Kind of Tax <br />(a) <br />Tax Period <br />Ending <br />(b) <br />• <br />Identifying Number <br />(c) <br />Date of <br />Assessment <br />(d) <br />Last ppAr for <br />Reining <br />(e) <br />Unpaid Balance <br />of Assessment <br />(1) <br />1040 <br />1040 <br />• <br />12/31/1987 <br />12/31/1987 <br />XXX -XX -7127 <br />XXX -XX -7127 <br />06/06/1988 <br />05/14/1990 <br />07/06/2018 <br />06/13/2020 <br />13931.66 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802 -1692 <br />$ 13931.66 <br />0,Dec,26. 2013 1:12PM NE Secretary of State — UCC <br />This notice was prepared and signed at <br />the 16th day of December 2013 <br />Signature <br />*4{ <br />for PATRICK J KELLOGG <br />CHICAGO, IL <br />No. 2582 P. 2 <br />Title <br />REVENUE OFFICER <br />(308) 6636003 <br />, 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.H. 409) Form 668(Y)(0 (Rev. 2.2004) 4 <br />G <br />Part 1 - Kwwt Ry Iteco Bias Office CAT. NO 60025X <br />