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crb <br />Sep. 29 2014 3:29PM NE Secretary of State — ACC No. 6967 P. 2/5 <br />Form 668 (Y)(c) <br />'Rev. February 2004) <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AMA #9 <br />Lien Unit Phone: (800) B29 -3903 <br />Name of Taxpayer EDWIN ORTEGA <br />Residence <br />Kind of Tax <br />(a) <br />Place of Filing <br />the <br />4804 <br />Tax Period <br />Ending <br />(b) <br />. 19th day of September 2014 <br />Department of the Treasury - internal Revenue Service <br />Notice of Federal Tax Lien <br />Identifying livaeber <br />(c) <br />Serial Number <br />As provided by section 6121, 6322, and 023 of the Internal Revenue <br />Code, we are giving a notke that taxes (Including Merest and penalties) <br />have been assessed against the fallowing -named taxpayer. We have made <br />a demand for payment of this liability, but k remains unpaid. Therefore, <br />there k a lien hi favor of the United States on all property and rights to <br />property bel.eging to this taxpayer for the amount of these taxes, and <br />additional penakies, interest, and costs that may accrue. <br />812 1/2 W 4TH ST <br />GRAND ISLAND, NE 68801 -4531 <br />.IMPORTANT RELEASE INFORMATION: For each assessment Bated below, <br />unless notice of the Ilen Is refiled by the dale given in column le), this notice shall. <br />on the clay following such data, operate as a certificate of release as defined <br />in IRC 6325(a)- <br />Assessment <br />(d) <br />Register of Deeds <br />Hall POBOX 1692 <br />Orand.Island, NE 68802 - 1692 <br />This notice was prepared and signed at CHICAGO, 11` <br />121073514 <br />Last <br />(e) <br />For option& <br />Total <br />201406196 <br />the by Recording Office <br />MC Se. .f VOA & JChr 11 Vale - MGM <br />90147426N-2 Pas: 1 <br />ORTEW � <br />Fill: 59r 12014 89:85 M <br />Unpaid Balance <br />of Assessment <br />(f) <br />, <br />1 <br />$ 45675.40 <br />, on this, <br />Signature Title SBSE 24 -00 -0008 <br />f G. J. CARTER - LOUIS (800) 829 -3903 <br />(NOTE Certificate of officer authorized by law to take acknowladpment is not essential to the validity of Notice 01 Federal Yax'nen <br />Rey. Mul. 71-466, 1971 - 2 C.B. 409) Form 66e(Y)(e) (Rev_ 2 -2 004 <br />Par' 1 - Kept By llecording Office CAT_ NO 60025X <br />