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Aug, 29. 21:117 28FM NE Secretary of State — UCC <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Area: <br />SMALL BUS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone! (BOO) 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 BRUCE A & CHRISTINE L OSENTOWSKI <br />Residence <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 />4302 BLAUVELT RD <br />GRAND ISLAND, NE 68803 -1401 <br />Tax Period <br />Ending <br />(b) <br />11874 <br />12/ <br />This notice was prepared and signed at <br />the <br />Signature <br />17th day of August <br />for G.J. GAR TER -LOUIS <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Identifying Number <br />(c) <br />XXX -XX -7329 <br />2017 <br />Serial Number <br />Date of <br />Assessment <br />(d) <br />11/07/2016 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NB 68802 -1692 <br />274991117 <br />Last Day for <br />Refining <br />(e) <br />12/07/2026 <br />Title <br />ACS SBSE <br />(800) 829 -3903 <br />Total $ <br />N .1784 <br />201705834 <br />For Optional Use by Recording Office <br />9 E191779724 4-0 P5 1 <br />osENT., <br />Unpaid Balance <br />of Assessment <br />(f) <br />30465.47 <br />30465.47 <br />CHICAGO, IL , on this, <br />24-00 -0008 <br />(NOTE Certificate of officer authorized by law to take acknowledgment ie not essential to the validity of Notice of Federal Tax lien <br />Rev. Rule 71 -466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev, 2 -2004) <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />