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:Jul,29. 2116 3:24FM NE Secretary of State — UCC <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Area: <br />$MALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (SOO) 829 - 3903 <br />As provlded 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 SHANNON CROSBY <br />Residence <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 -sueh- date - open -ate as- sa- cer- tifieste -of- release -as defined <br />in IRC 6325(a). <br />Kind of Tax <br />(a) <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />Place of Filing <br />This notice was prepared and signed at <br />Signature <br />Tax Period <br />Ending <br />(h) <br />5216 <br />12/31/2004 <br />03/31/2005 <br />06/ <br />09/30/2005 <br />12/31/2005 <br />03/31/2006 <br />06/30/2006 <br />09/30/2006 <br />12/31/2006 <br />03/31/2007 <br />06/30/2007 <br />09/30/2007 <br />12/31/2007 <br />03/31/2008 <br />06/30/2008 <br />for G.J. CARTER -LOUIS <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Serial Number <br />2680 SAINT PATRICK AVE <br />GRAND ISLAND, NE 68803 -1307 <br />Identifying Number <br />(c) <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX --4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />XXX -XX -4476 <br />Date of <br />Assessment <br />(d) <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />the 15th day of July 2016 <br />a k t- u-S- esrvvkaivi <br />221396016 <br />Title <br />ACS SBSE <br />(800) 829 -3903 <br />Total $ <br />207t604g74 <br />For Optional Use by Recording Office <br />aic sae a { John 5 9.1s - UCC FTL <br />1 CIE <br />9918777568 -2 P0s: 1 <br />CROSBY J ed: 07/29%2016 09:30 RM <br />List Day for Unpaid Balance <br />Reuling of Assessment <br />(e) (0 <br />01/13/2026 2861.05 <br />01/13/2026 4461.10 <br />01/13/2026 3589.01 <br />01/13/2026 4178.79 <br />01/13/2026 5202.78 <br />01/13/2026 5239.93 <br />01/13/2026 4646.09 <br />01/13/2026 5521.90 <br />01/13/2026 4477.52 <br />01/13/2026 5403.68 <br />01/13/2026 4820.70 <br />01/13/2026 5111.95 <br />01/13/2026 3637.75 <br />01/13/2026 1620.07 <br />01/13/2026 2238.36 <br />63010.68 <br />CHICAGO, IL , on this, <br />24 -00 -0008 <br />(NOTE Certificate of officer authorized by law to take acknowledgment is net essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71 -466, 1971 - 2 G.B. 409) Form 6611(Y)(c) (Rev. 2 -20041 <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />