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Form 668 (Y)(c) <br />(Rev. February 2004) <br />5216 <br />Department of the Treasury - Internal Revenue Service 2016035/5- <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 />213299316 <br />For Optional Use by Recording Office <br />ma <br />too or <br />stale <br />John <br />A 6.1. <br />- ucr FM, <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 />r <br />a demand for payment of this liability, but k remains unpaid. Therefore, <br />there is a lien in favor of the United States on all property and rights to <br />9916775188 <br />-8 <br />Pgs : <br />i <br />property belonging to this taxpayer for the amount of these taxes, and <br />Filed 5 0 6 "09 / 11:5 A <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer GIGGLES INC, a Corporation <br />Residence 1409 N WEBB RD <br />GRAND ISLAND, NE 68803 -2313 <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 />Ending <br />Identifying Number <br />Assessment <br />Refiing <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />941 <br />09/30/2015 <br />XX- XXX8886 <br />12/07/2015 <br />01/06/2026 <br />1164.28 <br />941 <br />12/31/2015 <br />XX- XXX8886 <br />04/04/2016 <br />05/04/2026 <br />7345.77 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 8510.05 <br />Grand Island, NE 68802 -1692 <br />b8 Jun. 9. 2016 3:54FM NE ...r Lary of State - UCC <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 18th day of May 2016 <br />Signature <br />for PATRICK J KELLOGG <br />Title <br />REVENUE OFFICER <br />(308) 663 -6003 <br />No. 6863 <br />24 -06 -2744 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not eaaential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71 -466, '1971 - 2 C.9. 409) 111 <br />Part 1 - Kept By Recording Office Form 668(lt (Rev. Z 2004) <br />CAT. NO 60025X <br />