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the <br />Mar.29. 20117 3:37PM NE Secretary of State — UCC, <br />Form 66B (1)(c) <br />(Rev. February 2004) <br />11874 <br />Area: <br />SMALL BUS IVSS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 - 6050 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <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 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 GIGGLES INC, a Corporation <br />Residence <br />1409 N WEBB RD <br />GRAND ISLAND, NE 68803 -0000 <br />252541917 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (a), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />In IRC 6325(a). <br />Kind of Tax <br />(a) <br />941 <br />Place of Filing <br />Signature <br />for PATR <br />Tax Period <br />Ending <br />(b) <br />09/30/2016 <br />This notice was prepared and signed at <br />13th day of March <br />Identifying Number <br />(c) <br />XX- XXX8886 <br />Register of Deeds <br />Hall POBOX '1692 <br />Grand Island, NE 68802 -1692 <br />2017 <br />ttbek- <br />Date of <br />Assessment <br />_ (d) <br />01/09/2017 <br />'CHICAGO, IL <br />Last Day for <br />( e) <br />02/08/2027 <br />Total <br />20 <br />For Optional Use by Recording Office <br />E Sec of Skate Sohn R Dolt. - UGC <br />GTL <br />9917789461 -0 Pea: 1 <br />GIGGLES : 03/29/2017 R7 02R1 I <br />02:12 PM <br />Unpaid Balance <br />of Assessment <br />14705.06 <br />$ 14705.06 <br />, on this, <br />Title <br />REVENUE OFFICER <br />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 />0.... 71_A Ca 9071 - 7 r Fl 111191 e___ £ZOMr.% SO.... o. "nnnl <br />24 -06 -3124 <br />