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Form cr 04) <br />{Rev_ February 2004) <br />14583 <br />Department of the Treasury - internal Revenue Service <br />Notice of Federal Tax Lien 2 01 4 0 3 3 3 3 <br />Area: <br />WAGE & xxvxwmnairr AR2A. in <br />Lien Unit Phone: (Boo) 828 -7650 <br />Serial Number <br />101814714 <br />For Optional Use by Recording Office <br />wigs of ■+•{e <br />111 <br />99147368/9 <br />WRIG 06/05/2014 <br />John <br />111 <br />-3 <br />n ®eta - UCC Rtt <br />11111111 <br />PBS: 1 <br />10:50 A'! <br />- <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are gluing a notke that taxes (Including interest and penalties) <br />have been assessed against the following -roamed taxpayer. We have made <br />a demand for payment of this IiabiBty, 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 this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer JERAMIB L WRIGHT <br />Residence 518 E CAPITAL AVE TRLR 33 <br />GRAND ISLAND, NE 68$01 - 2472 <br />I MPORTANT RELEASE INFORMATION: F or each assessment listed below, <br />unless notice of the lien is reified by the date given in column (el, This notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(al- <br />Kind of Tax <br />(a) <br />Tax Period <br />Ending <br />(b) <br />Identifying Number <br />(c) <br />Date of <br />Assessment <br />(d) <br />Last Darr for <br />g <br />( <br />Unpaid Balance <br />of Assessment <br />(f) <br />1040 <br />12/31/2001 <br />XXX -XX -4220 <br />03/01/2004 <br />03/31/2024 <br />12006.25 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grad Island, NE 68802 -1692 <br />$ 12006.25 <br />Jun, F, 2014 3:26PM .NE Secretary of State - UCC <br />This notice was prepared and signed at CHICAGO, IL <br />the 27th. day of May 2014 <br />No. 5136 P. 2/2 <br />, an this, <br />Signature "7." r� W� ACS W &I Title for MARY T. DELACRUZ (800) 829 -7650 <br />(NO Certificate of offioir authorized by low to take acknowledgment is not essential to the validity of Notice of Federal Tax lian <br />Rev. Rul, 71 -466, 1971 - 2 C.B. 4051 i ) <br />14 -00 -0000 <br />Park 1 • kW By Rewrdf.a Office Form 668(Y)(0) Mee. 2- 20041/ <br />CAT. NO 000ZOX <br />