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3514 <br />Form 668 (Y)(c) <br />(Rev, Fetuuary 2004) <br />-Aor, 1. 2015 3:20PM NE Secretary of State — UCC <br />Area: <br />SMALL BVSINES.5 /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (80i)) 913 - 6050 <br />As provided by section 6121, 6322, and 6323 of the Internal Revenue <br />Code, we are gluing 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 United States en all property and rights to <br />property belonging to this taxpayer yer for the amours of these taxes, and <br />additional penalties, interest, and costs that may atom. <br />Name of Taxpayer EIJWIN S ERLAND <br />Residence <br />Kind of Tax <br />(a)._ <br />1040 <br />Place of Fling <br />Signature <br />for REBECCA J DINNING <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Serial Number <br />804 N BOGGS AVE APT 419 <br />GRAND' ISLAND, NE 68803 -4415 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refllad by the date given in column (e), this notice shall, <br />on the day followir)g suds date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />Tax Period <br />Ending <br />(b) <br />12/31/2011 <br />Identifying Number <br />(c) <br />XXX -XX -1725 <br />the 06th day of February 2015 <br />• <br />Date. of <br />Assessment <br />(d) <br />01/12/2015 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />143390615 <br />Title <br />REVENUE OFFICER <br />(515) 564 -6662 <br />(NOM Certificate of officer authorised by law to take acknowledgment is not essential to the validity <br />Rev, Rul. 71-466, 1971 - 2 C.B. 409) <br />Pat 1 - kept iy Itaosretag OfHta <br />No, 0041 <br />201502003 <br />For Optional Use by Recording Office <br />PR SM of Stain 1d.. a Gel- - I,Cc CTL <br />9915751447 -2 Pao' c <br />cn N gDYIN <br />Flied: 5410112 <br />e15 11:04 W( <br />last <br />(e) <br />02/11/2025 <br />( t) <br />This notice was prepared and signed at CHICAGO, IL <br />Li L <br />Unpaid d Balance <br />of <br />5660.36 <br />Total $ 5660.36 <br />on this, <br />24 -06 -2319 <br />of Notice of Federal Tax ben <br />4 ( <br />Fenn 668(Y)(c) (Rev. 2 -200 <br />CAT. NO 60025X <br />