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Form 668 <br />2 a (> 0041 <br />(Rey. February <br />u0044 <br />14582 <br />Department of the Treasury - Internal Revenue Service <br />201,503 <br />N of Federal Tax Lien <br />, <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA 1)4 <br />Lien Unit Phone: (800) 913 - 6050 <br />Serial Number <br />155055015 <br />For Optional Use by Recording Office <br />, ,.. A Cu►. <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 />'" `" <br />- ucc �� <br />"' <br />have been assessed against tine followkg-named taxpayer. We have made <br />1 <br />111 <br />101 <br />a demand for payment of this liility, but k reakes unaid. Therefore, <br />there h a lien in favor of tine United States on aU property and rights to <br />1 <br />property belong to this taxpayer for the amount of these taxes, and <br />W IE no Pc R CORPORAT t <br />addltlonal penaides, interest, and costs that may accrue. <br />Fired: 05/21i2015 0 AM <br />Name of Taxpayer LTANA VAN WIE MD PC, a Corporation <br />Residence 1917 W k'AIDLEY AVE <br />GRAND ISLAND, NE 68803 -4642 <br />IMPORTANT RELEASE INFORMATION: F or each assessment listed b elow, <br />unless notice of the perils reified by the 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 />Tax Period <br />Date of <br />' Last for <br />unpaid Balance <br />Kind of Tax <br />Ending <br />IdendI Number <br />Assessment <br />Ref14 <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />( <br />941 <br />12/31/2013 <br />27-3084076 <br />04/07/2014 <br />05/07/2024 <br />- - -- <br />9451.04 <br />941 <br />03/31/2014 <br />27- 3084076 <br />06/02/2014 <br />07/02/2024 <br />8914.27 <br />941 <br />06/30/2014 <br />27- 3084076 <br />12/15/2014 <br />. 01/14/2025 <br />11529.34 <br />941 <br />09/30/2014 <br />27- 3004076 <br />12/22/2014 <br />01/21/2025 <br />6641,89 <br />941 <br />12/31/2014 <br />27- 3084076 <br />02/23/2015 <br />03 <br />852.01 <br />Placa of Riling <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 37388.55 <br />Grand Island, NE 68802 -1692 <br />May, 21, 2015 3:29PM NE Secretary of State — UCC <br />This notice was prepared and signed at <br />t h e 29tri day of APril 2015 <br />CHICAGO, IL <br />No. 0902 <br />, on this, <br />Signature ? LL Title <br />REVENUE OFFICER 24 -06 -2720 <br />for DANIELLE L ER (402) 473 -4675 <br />(NOTE Certificate of officer authorized by law to take acknowledgment is not essential to the vaidity of Notice of Federal Tax lien <br />Rev- Rd- 71-466.1971 - 2 C.B. 4091 Form 668(10(c) Uiev. Z-2004) <br />Pwi 1 - reps lig RO°ording OM= CAT. NO 60025X <br />el <br />