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•Dec, 7. 2516 3:11PM - - NE Secretary of State — UCC <br />DD <br />Form 668 (Y)(c) <br />(Nev- February 2004) <br />Area: Serial Number <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (000) 913 - 6050 <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 />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 TOURNEY BROTHERS METAL FABRICATION <br />Residence <br />Kind of Tax <br />(a) <br />the <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 />941 <br />Place of Filing <br />Tax Period <br />Ending <br />(b) <br />14742 <br />104 E 6TH ST <br />WOOD RIVER, NE 68883 <br />03/31/2016 <br />Identifying Number <br />(c) <br />XX XXX8025 <br />29th day of November 2016 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Date of <br />Assessment <br />(d) <br />07/11/2016 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />239734416 <br />DiNw 1 . Want , Ysrnrrrins Arfira <br />Last Day for <br />Refiiing <br />(e) <br />08/10/2026 <br />N0.8994 P. 3 <br />201608219 <br />For Optional Use by Recording Office <br />NE Sac of 54.4. john A dole - ACC FTL <br />- 11 11 <br />ll <br />8916783638 -9 Pas: 1 <br />TOURNEY BROTHERS PETAL FeBRICq <br />Filed: 12/07/2016 10:00 API <br />Total $ <br />Unpaid Balance <br />of Assessment <br />(f-) <br />4461.61 <br />4461.61 <br />This notice was prepared and signed at CHIC ' IL , on this, <br />Signature REVENUE OFFICER <br />for PATRICK KELLOGG (308) 663-6003 <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 - 06 - 3124 <br />Form 668(Y)(c) (Rev. 2 -2004) <br />