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Jun. 14. 2017 3:01FM NE Secretary .f State — UCC 11o, 1553 F. 2;'10 <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br />11874 <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829 -3903 <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 PHILLIP A BECKETT <br />Residence <br />the <br />913 W 11TH ST <br />GRAND ISLAND, NE 68801 - 4013 <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 />Kind of Tax <br />(a) <br />1040 <br />Place of Filing <br />Tax Period <br />Ending <br />(b) <br />12/31/2004 <br />26th day of May <br />Department of the Treasury - internal Revenue Service <br />Notice of Federal Tax Lien <br />Identifying Number <br />(c) <br />XXX -XX -8604 <br />2017 <br />Serial Number <br />Date of <br />Assessment <br />(d) <br />12/24/2007 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />264012117 <br />Last Day for <br />Refilmg <br />(e) <br />01/23/2018 <br />Title <br />ACS SBSE <br />(800) 829 -3903 <br />201703966 <br />For Optional Use by Recording Office <br />NE S. of Ito!„ John A Gal. - UCC FTL <br />I 111 1.11 <br />9917793523 -8 Pas: 1 <br />BECKETT PHILLIP A <br />Filed: 06 /14/2017 11:02 AM <br />Unpaid Balance <br />of Assessment <br />(f) <br />10781.42 <br />Total' $ 10781.42 <br />This notice was prepared and signed at CHICAGO IL , on this, <br />24 -00 -0008' <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. Rol. 71 -466, 1971 - 2 C.B. 4091 Form 660(Y)(c) (Rev. 2- 2004)- <br />Part 1 - Kept By Recording Office CAT. NO 80025X( <br />