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06/01/2001 16:51 FAX 14024714429 NEBRASKA tCC <br />[x004 <br />109 <br />Department of the Treasury - Internal Revenue Service <br />Form 668 (Y)(c) Notice of Federal Tax Lien <br />(Rev. October 2000) <br />lll t 1 l Area: Serial Number Fr Ii1�����III, <br />WAGE & INVESTMENT AREA #5 390147012 I�fi <br />Lien Unit Phone: (Boo) 829 -7650 <br />and 6323 of the internal Revenue LOPEZl GLAD YS R <br />As provided by section 6321, 6322, Filed: 06rOt!2001 03:55 PM <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 GLANS R LOPEZ <br />200105279 <br />Residence PO BOX 1701 <br />GRAND ISLAND, NE 68802 -1701 <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 6326(a1• <br />Tax Period Date of Last Day for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refilling of Assessment <br />1040 <br />112/31/19971 <br />12/31/1995 <br />610 -48 -6249 <br />05/31/1999 <br />09/20/1999 <br />06/30/2009 <br />10/20/2009 <br />1882.10 <br />2057.95 <br />1040 <br />1040 <br />12/31/1996 <br />610 -4B -6249 <br />610 -48 -6249 108/14/20001 <br />09/13/2010 <br />1955.17 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 26th day of May <br />MILWAUKEE, WI <br />2001 <br />Total 1$ <br />5895.22 <br />, on this, <br />Signature ACS 39-01-0000 <br />for J D EPP I (800) 829 -7650 <br />(NOTE: Certificate of officer authorized Y law to take cknowledgment is not essential to the validity of Notice of Federal Tax liar <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 4091 Form 666(Y)(c) (Rev. 10 -00) C� <br />Part 2 . iasernal Revenue Service TDA Copy CAT. NO 60025X �+` <br />