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0 9 , 7 Oct, 19. 2015 2:4 FM NE Secretary of State - UCC <br />5216 <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Area: <br />SMALL BUSINESS /StLF 13r'M$L0YRD ARRA #4 <br />Lien Unit Phone: (800) 029 -3903 <br />Name of Taxpayer PAUL & JESSICA PANKONIN <br />Residence <br />Kind of Tax <br />(a) <br />1040 <br />1040 <br />1040 <br />1040 <br />• Place of Filing <br />Tax Period <br />Ending <br />.(b) <br />12/31/2010 <br />12/31/2011 <br />12/31/2012 <br />12/31/2013 <br />Identifying Number <br />(c) <br />XXX -XX --4006 <br />XXX -XX -4006 <br />XXX -XX -4006 <br />XXX -XX -4006 <br />This notice was prepared and signed at <br />the . 01st da y of october 2015 <br />Department of the Treasury - Internal Revenue ServiGe2 01507114 <br />Notice of Federal Tax Lien <br />Serial Number <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 hi 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 />1016 PLEASANT VIEW DR <br />GRAND ISLAND, NE 68801 -8022 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), thls notice shall, <br />•on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />Date of <br />Assessment <br />(d) <br />05/30/2011 <br />05/28/2012 <br />06/03/2013 <br />06/02/2014 <br />Register of Deeda <br />. Hall POBOX.1692 <br />Grand Island, NE 68802 -1692 <br />CHICAGO, IL <br />179551615 <br />For <br />Last Day For <br />Refing <br />(e) <br />06/29/2021 <br />06/27/2022 <br />07/03/2023 <br />07/02/2024 <br />Optional thee by Recording office <br />NE t.c ei Ststo Joh. N Gal. - UCC ETL <br />• <br />9915762554 -2 Pest 1 <br />PANKONIN PAUL <br />Filed: 1 0/19/2015 e1:45 PM <br />Total <br />N. 3171 F 21/2 <br />Unpaid Balance <br />of Assessment <br />(() <br />4763.15 <br />15249.70 <br />6171,46 <br />2249.42 <br />$ 28433.73 <br />, on this, <br />Signature <br />tor Title <br />ACS SBSE <br />far G.J . CA.R.rER oUIS (800) 829 <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. 409) <br />24 -00 -0008 <br />Form 668(Y)(c) (Rev. 2 -2004) <br />Part 1 - Kept By Recording Office CAT. NO 60025X r <br />Li <br />