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Jan. 22. 2018 3:04FM NE 'Secretary of State — UCC No. 3304 <br />Form 668 (Y)(c) <br />(Rev. February 2004) <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 Hen 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 TOMS DELIVERY SERVICE INC <br />a Corporation <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 />lUnd of Tax <br />(a) <br />941 <br />941 <br />941 <br />941 <br />Place of Filing <br />2407 W 4TH ST <br />GRAND ISLAND, NE 68803 -4507 <br />Tax Period <br />Ending <br />(b) <br />09/30/2016 <br />12/31/2016 <br />03/31/2017 <br />06/30/2017 <br />Identifying Number <br />(c) <br />XX-XXX63 03 <br />XX- XXX6303 <br />XX- XXX6303 <br />XX- XXX6303 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the <br />Signature <br />for G.J. <br />21st day of December 2017 <br />• <br />TER -LOUIS <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Serial Number <br />Date of <br />Assessment <br />(d) <br />01/02/2017 <br />04/03/2017 <br />07/03/2017 <br />09/18/2017 <br />290666917 <br />Last Day for <br />Reining <br />(e) <br />02/01/2027 <br />05/03/2027 <br />08/02/2027 <br />10/18/2027 <br />Title <br />ACS SBSE <br />(800) 829 -3903 <br />For Optional Use by Recording Office <br />Total $ <br />201800433 <br />C S.c of 5 !Mr Jahn R (1610 UCC FTL <br />9918804801 -4 Paz: 1 <br />TOMS DELIVERY SERVICE INC A CO <br />Flied: 01/22/2010 10:51 RM <br />Unpaid Balance <br />of Assessment <br />(f) <br />891.72 <br />8776.85 <br />15646.43 <br />19442.42 <br />44757.42 <br />24 -00 -0008 <br />(NUM: Certificate of officer authorized by Pew to take acknowledgment is not essential to the validity of Notice of Federal Tex lien <br />Rev. Hui. 71 -468, 1971 - 2 C.B. 4091• <br />Part 1 - Kept By Recording Office Form 66130)(c) IRev. 2 20D4) <br />