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Form 6613 (Y)(c) <br />(Rev, February 2004) <br />11290 <br />Department of the Treasury - Internal Revenue Service <br />201504634 <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 -6050 <br />Serial Number <br />163003715 <br />For Optional Use by. Recording Office <br />pRUEdL <br />NE <br />, 1I 1 <br />1� 1 <br />/ , <br />9915757405 <br />See of <br />1 1 <br />� i <br />�,,�, <br />07/09 <br />54.ie <br />;'; <br />1� <br />1� <br />���� <br />Jahn <br />�'I <br />it <br />" <br />I <br />-0 <br />A Rear <br />fll <br />Ij <br />� <br />71:10 <br />- UCC <br />I <br />1 <br />�� <br />Pgs <br />AM <br />FTL <br />�1I <br />I�i <br />: <br />7 <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 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 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 JAMES H TRTJELL <br />Residence 903 W DIVISION ST <br />GRAND ISLAND, NE 68801 -6451 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled 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 />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 Day for <br />Refling <br />(e) <br />Unpaid Balance <br />of Assessment <br />(f) <br />1040 <br />12/31/2013 <br />06/3.7/2025 <br />28036.04 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802-1692 <br />$ 28036.04 <br />This notice was prepared and signed at . CHICAGO, TL , on this, <br />the <br />Jul, 9. 2016 2:51PM NE 5cre.tdry of State — UCC <br />19th day of June ' 2015 <br />Signature l sr4 <br />for DANIELLE L MUELLER <br />Title <br />REVENUE OFFICER <br />(402) 473 -4675 <br />No. 1718 P. 2; 6 <br />24 -06 -2720 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71- 466,.1971 - 2 C.9.409) Form 66$(Y)(c) (Rev. 2 -2004) <br />pave 1 - V.m..► R.. Oor....Yi.... natra <br />