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Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (B00) 913 -6050 <br />Serial Number <br />269125117 <br />For Optional Use by Recording Office <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />"" 5k. of seta <br />Jahn " 6 <br />-114 <br />- ucc <br />FYI. <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 k 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 />9 917795731 -1 <br />FRIESEN TODD W <br />Pea <br />1 <br />additional penalties, interest, and costs that may accrue. <br />Filed: 07/Z7/2017 11,00 AM <br />Name of Taxpayer TODD W FRIESEN <br />Residence 816 SUN VALLEY PL <br />GRAND ISLAND, NE 68801 <br />IMPORTANT RELEASE : For each assessment listed below, <br />unless notice of the lien 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 />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />identifying dumber <br />Assessment <br />Refing <br />of Assessment <br />( <br />( <br />(d) <br />(e) <br />(f) <br />1040 <br />12/31 <br />NNNNC <br />000000 <br />05/16/2011 <br />06/15/2021 <br />1010.39 <br />1040 <br />12/31 <br />05/28/2012 <br />06/27/2022 <br />5304.86 <br />1040 <br />12/31 <br />11/18/2013 <br />12/18/2023 <br />7366.41 <br />1040 <br />12/31 <br />03/17/2014 <br />04/16/2024 <br />972.97 <br />1040 <br />12/31 <br />10/05/2015 <br />11/04/2025 <br />8050.04 <br />1040 <br />12/31 <br />06/06/2016 <br />07/06/2026 <br />3723.55 <br />• <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 26428.22 <br />Grand Island, NE 68802 -1692 <br />Jul, 27. 20117 2:06PM NE Secretary f State — UCC <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />the <br />Signature <br />11874 <br />05th day of July 2017 <br />for G.J. TER -LOUIS <br />5" a <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />2 0 0 '04 0 <br />This notice was prepared and signed at CHICAGO, IL , on this <br />Title <br />ACS SBSE <br />(800) 829 -3903 <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. Rul, 71-406, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2 -2004) <br />Part I - Kept fay Recording Office rAT Mn ann7sx <br />