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Mar. 28, 2014 3:O9PM NE Secretary of State — UCC No. 4021 <br />Feral 668 (Y)(c) <br />!Rev. February 2004) <br />14583 <br />'Area: <br />SMALL BUSINESS /S7ElfF RMPLOY'ED AREA #4 <br />Lien Unit Phone: (800) 93.3 -6050 <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 linked States on all property and rights to <br />property belonging to this taxpayer for the amoum of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer JAY B JI']'DDS <br />Residence <br />664 RISCHLLD ST <br />GRAND ISLAND, NE 68801 -7895 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is reliled by tha 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 />1040 <br />Place of Filing <br />Tax Period <br />Ending <br />(b) <br />12/31/2012 <br />Identifying Number <br />(c) <br />XXX -XX -6893 <br />Rug1uter of weds <br />Hall POBOX 1692 <br />Grand Inland, NE 68802 -1692 <br />This notice was prepared and signed at , on this, <br />the 17th day of March 2014 <br />Signature <br />for PATRICK J KELLOGG <br />Notice of Federal Tax Lien <br />Serial Number <br />Assessment <br />(d) <br />06/03/2013 <br />989707214 <br />Last for <br />(e) <br />07/03/2023 <br />Ti <br />OFFICER <br />• (308) 663-6003 <br />For Options( l.lse by Recording Office <br />Id % a4 S {d. inhn • Ear. • Ill[ FTL <br />9914732970 -e PS5 ; 1 <br />JUDOS JAY B <br />Filed: 83!2812014 01:18 PM <br />• <br />201 401 747 <br />Unpaid Balance <br />of Assessment <br />(1) <br />1927.37 <br />Total $ 1927.37 <br />24 -10 -1744 <br />(NOTE; Certificate of officer authorized by law to take acknowledgment le not essential to the val)drty of Notice of Federal Tax lien <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 409) <br />Pat 1 - Kept ay Recotn6ag Office Form 668(Y)(c) (Rev. 2 <br />CAT. NO 60025X <br />