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form 668 (Y)(c) <br />(Rev. February 2004) <br />Area: <br />SMALL BUSIJESS /SELF EMPLOYED ARRA1 #4 <br />Lien Unit Phone: (Boo) 913 -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 Mowing-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 United States on al 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 TERESA RUZICRA <br />Residence <br />Kind of Tax <br />(a) <br />6672 <br />6672 <br />6672 <br />6672 <br />Place of Filing <br />the <br />Signature <br />,24: 2014 3:43PM NE Secretary of State — UCC <br />11290 <br />for G.J. CARTER LOUIS <br />816 E SOUTH S T <br />GRAND ISLAND , NE 68801 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column lel, 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 />06/30/2011 <br />0 <br />03/31/201 <br />06/30/2012 <br />Department of the Treasury - internal Revenue Service <br />Notice of Federal Tax Lien 201402451 <br />Identifying Number <br />(c) <br />XXX -XX -4198 <br />XXX -MX-4198 <br />XXX -XX -4198 <br />XXX -XX- 4 19 a <br />Register of Deeds <br />Ha] ] POBOX 1692 <br />Grand Island, NE 688021692 <br />This notice was prepared, and signed at . CHICAGO, IL <br />on this, <br />15th day of April <br />2014 <br />Serial Number <br />Date uf <br />Assessment <br />(d) <br />03/11/20 <br />03/11/2013 <br />03/11/2013 <br />03/11/2013 <br />Part 1 • Kept 11y Office <br />9951064x'4 <br />Last_ Dad► g fior <br />(e) <br />04/10/2023 <br />04/10/2023 <br />04/10/2023 <br />04/10/2023 <br />Title <br />ACS SBSE <br />(800) 829 -3903 <br />No, 4464 P. 4/6 <br />For Optional Use by Recording Office <br />NE Sc. of Si M• John 1 6ele - 0CC iTL <br />!III 1111 <br />9914T34612 -e Pas: t <br />t2ICKA TERESA <br />Filed: 04/24/2014 02:34 PM <br />Unpaid Balance <br />of Assessment <br />(f) <br />710.48 <br />7341.24 <br />6693.26 <br />5922.50 <br />Total $ 20667.48 <br />24 -00 -0008 <br />(NOTE Cartifrate of officer authorized by law to take aoknewledgment is not essential to the validity o 0 f Notice f Federal r 1 T Ilan <br />Rev. Rul. 71 -460, 1971 - 2 C.B. 409) <br />Form 66e(Y)(C) (Rev. 2 2004,1 <br />CAT. NO 80025X 1 <br />