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Feb. 22. 2017 4:13FM NE Secretary of State — UCC <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (000) 913 - 6050 <br />Name of Taxpayer TARA J GRAVES <br />Residence <br />Kind of Tax <br />(a) <br />1040 <br />1040 <br />Place of Filing <br />11874 <br />Tax Period <br />Ending <br />(b) <br />12/31/2012 <br />12/31/2013 <br />This notice was prepared and signed at <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Identifying Number <br />(c) - <br />XXX -XX -3427 <br />XXX -XX -3427 <br />the 02nd day of February 2017 <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 Hen 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 />2422 W 18TH ST <br />GRAND ISLAND, NE 68803 -2606 <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 />Date of <br />Assessment <br />(d) <br />09/12/2016 <br />09/12/2016 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />247902517 <br />Last Day for <br />Refiling <br />(e) <br />10/12/2026 <br />10/12/2026 <br />No. 9762 F. 4/5 <br />201701165 <br />For Optional Uae by Recording Office <br />E Sec of S4a4e Jah^ H Gels <br />9917787503 -5 <br />GRRVE6 TARR J <br />Filed: 02/2212017 10:49 1 1 <br />(f) <br />Unpaid Balance <br />of Assessment <br />225321.37 <br />142197.48 <br />Total $ 367518.85 <br />CHICAGO, IL , on this, <br />Si 0114AN Title <br />REVENUE OFFICER <br />for PATRICK KELLOGG (308) 663 - 6003 <br />24 -06 -3124 <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. Rule 71 -466, 1971 - 2 C.e. 4091 Form 66B(Y)(c) (Rev. 2 -2004) <br />Part 1 - Kept By Recordlns Office CAT. NO 60025X 116/ <br />