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Form bbe (Y)(c) <br />041 <br />(Rgv. February 2004) <br />14583 2014007 <br />Department of the Treasury - internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: <br />SHALL BUSINESS /SELF EMPLOTED AREA #4 <br />Lien Unit Phone: (800) 829 -3903 <br />Serial Number <br />982946214 <br />For Optional Use by Recording Office <br />N . ,., a 5..4.3.6., A GO C "CC P7 <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a nodce 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 Dabftky, 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 thin taxpayer for the amount of these taxes, and <br />7-4 po'° 1 <br />additional penalties, interest, and costs that May accrue. <br />sow WENT Doua-as <br />Filed, 92r11J2e14 01. es rn <br />Name of Taxpayer RENT DOUGLAS SHAW <br />Residence 2323 BELLWOOD DR TRLR 142 <br />GRAND ISLAND, NE 68801 -6206 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />urdess notice of the lien is refiled by the date given in column (e), this notice shell, <br />on the day following such date, operate as a certificate of release as defined <br />In 1RC 6325(a). <br />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying plumber <br />Assessment <br />Railin <br />of Assessment <br />(a) <br />(b2 <br />(c) <br />(d) <br />(e) <br />-- (f) <br />- <br />1040 <br />12/31/2004 <br />XXX -XX -1115 <br />08/08/2011 <br />09/07/2021 <br />7292.91 <br />1040 <br />12/31/2005 <br />XXX -X,X -1145 <br />08/08/2011 <br />09/07/2021 <br />23674.93 <br />1040 <br />12/31/2006 <br />XXx -XX -1115 <br />08/08/2011 <br />09/07/2021 <br />12904.68 <br />1040 <br />12/31/2007 <br />XXX - XX - 1115 <br />08/08/2011 <br />09/07/2021 <br />14401.79 <br />1040 <br />12/31/2008 <br />XXX -XX -1115 <br />08/08/2011 <br />09/07/2021 <br />11493.44 <br />Feb. 11, 2014 2:28PM ,NE Secretary of State — UCC • <br />Place of Filing <br />This notice was prepared and signed et <br />the 04th day of February 2 014 <br />Signature <br />for G.i7. CARTER -LOUIS <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />CHICAGO, IL <br />Title <br />ACS SBSE <br />(800) 829 -3903 <br />Total <br />No.3293 P. 6/6 <br />$ 69767.75 <br />, on this, <br />24 -00 -0008 <br />Mom Certificate of officer au1hori2 d by law to take acknowledgment is not essential to tha validity of Notice of Federal Tax lien <br />Flew. Rol_ 71 -486, 1971 - 2 C.9. 4091 Form 66B(Xc) (Rev. 2 - 2004) <br />Peet 1 - kept Hy Reeerdleg Office • CAT, NO 60025X <br />