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Form 668 (Y)(c) <br />(Rev. February 2004) <br />14742 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />•Area: • <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Serial Number <br />For Optional Use by Recording Office <br />Lien Unit Phone: (800) 913 - 6050 <br />. 226654616 <br />N E <br />Soo <br />of <br />6iAkv <br />t <br />John <br />R Gala <br />- UCC <br />F Y <br />.As provided by section 6321, 6322, and 6323 or 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 />' .9916779790 <br />-3 <br />Peg: 1 <br />property belonging to this taxpayer for the amount of these taxes, and <br />FI @ /201e 56 <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer GIGGLES INC, a Corporation <br />Residence 1409 N WEBS RD <br />GRAND ISLAND,. NE 68803 -2313. <br />. <br />IMPORTANT RELEASE INFORMATION: 1✓or each assessment listed below, <br />unless notice of the lien is reified 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 />• Last Day. for <br />Unpaid Balance <br />Kind of Tax <br />Ending . <br />Identifying Number <br />Refiling <br />• of Assessment <br />(a) ' <br />(b) <br />• (c) <br />(e) <br />• (0 <br />941 <br />03/31/2016 <br />XX-XXX8886 <br />07/04/2016 <br />08/03/2026 <br />11540.31 <br />• <br />Place of Filing <br />. Regi s te r of Deeds • . <br />Hall POBOX 1692 Total <br />$ 11540.31 <br />Grand Island, NE 68802 -16 <br />Sep. 13. 2016 4:13FM NE Secretary of State — UCC <br />This notice was prepared and signed at - CHICAGO, IL , on this, <br />the <br />Signature <br />24th day of August . 2016 <br />for PATRICK KELLOGG . <br />(NOTES Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien • <br />Rev. Rul. 71-465, 1971 2 C.B. 409) • Form 666(Y)(c) (Rev. 2 <br />Title <br />REVENUE OFFICER <br />(308) 663-6003 - <br />2011606008 <br />.24 -06 -3124 <br />