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Form 668 (Y)(c) <br />(Rey. February 2004) <br />11290 4 00 <br />Department of the Treasury - Internal Revenue Service V <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829 -3903 <br />Serial Number <br />165011015 <br />For Optional Use by Recording Office <br />ME See of i4a4A John A G.lQ - ACC FT <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 />9915758149 <br />--7 <br />Pas; <br />1 <br />property belonging to this taxpayer for the amount of these taxes, and <br />SIMMONS LECTRIC z0 q (3M <br />Filed: 07a1/2015 ma� art <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer SIMMONS ELECTRIC INC, a Corporation <br />Residence PO BOX 5823 <br />GRAND ISLAND, NE 68802 -5823 <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 />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />End <br />Number <br />Assessment <br />Refiling <br />of Assessment <br />(a) <br />(i ) <br />(c) <br />(d) <br />(e) <br />(f) <br />940 <br />12/31 <br />cv) 1 ch r't cn M m cn c+1 rn <br />V V cl+ CN V V V V+ d <br />0000000000. <br />01/05/2015 <br />02/04/2025 <br />1945.99 <br />940 <br />12/31 <br />01/05/2015 <br />02/04/2025 <br />2004.82 <br />941 <br />03/31 <br />04/01/2013 <br />05/01/2023 <br />2657.68 <br />941 <br />06/30 <br />04/01/2013 <br />05/01/2023 <br />2698.53 <br />941 <br />09/30 <br />04/01/2013 <br />05/01/2023 <br />2738.51 <br />941 <br />12/31 <br />01/05/2015 <br />02/04/2025 <br />8457.41 <br />941 <br />03/31 <br />01/05/2015 <br />02/04/2025 <br />3789.44 <br />941 <br />06/30 <br />01/05/2015 <br />02/04/2025 <br />3757.12 <br />941 <br />09/30 <br />01/05/2015 <br />02/04/2025 <br />3725.09 <br />941 <br />12/31 <br />01/05/2015 <br />02/04/2025 <br />3673.44 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 35448.03 <br />Grand Island, NE 68802 -1692 <br />the <br />Jul, 21. 201 3:20FM NE 'Secretary o t tate — UCC <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />Signature <br />02nd day of July 2015 <br />D OSrd to <br />for G.J. CARTER -LOUIS <br />Title <br />ACS SBSE <br />(800) 829 -3903 <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.B. 4091 Form 668(Y)(c) (Rey. 2 -2004) <br />N' -' 1VVV <br />24- 00-0008 <br />