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Jan. 22. 201E 9:04FM NE Secretary of State — UCC No.3304 E 3/6 <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #6 <br />Lien Unit Phone: (Boo) 913 - 6050 <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 TORY M SEMM <br />Residence <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the data 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 />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />Place of Filing <br />the <br />Signature <br />for COLE <br />Tax Period <br />Ending <br />(b) <br />12/31/2009 <br />12/31/2004 <br />03/31/2005 <br />06/30/2005 <br />09/30/2005 <br />12/31/2005 <br />03/31/2006 <br />06/30/2006 <br />09/30/2006 <br />12/31/2006 <br />03/31/2007 <br />06/30/2007 <br />09/30/2007 <br />12/31/2007 <br />03/31/2008 <br />11874 <br />22nd day of December 2017 <br />CHWAN <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Identifying Number. <br />(C) <br />XXX- XX- 8961 <br />XXX -XX -8961 <br />XXX - - 8961 <br />XXX -XX -8961 <br />XXX - XX - 8961 <br />XXX -XX -8961, <br />XXX -XX -8961 <br />XXX -XX --8961 <br />XXX -XX -8961 <br />XXX -XX -8961 <br />XXX -XX -8961 <br />XXX - XX- 8961 <br />XXX -XX -8961 <br />XXX -XX -8961 <br />XXX -XX -8961 <br />Serial Number <br />4174 ARIZONA AVE <br />GRAND ISLAND, NE 68803 -1110 <br />Date of <br />Assessment <br />(d) <br />05/21/2012 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />12/14/2015 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />291004417 <br />Title <br />REVENUE OFFICER <br />(402) 473 -4671 <br />For Optional Uae by Recording Office <br />201800434 <br />I E iat of 54.1e Jahn H ).1 - UC[ FSL <br />11 1 <br />1 <br />i <br />9918904002 -6 Pea: 1 <br />SEMM TORY M <br />Filed: 01122/2018 10:51 AM <br />Last Rai for <br />or <br />00 <br />( M <br />06/20/2022 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />Total $ <br />Unpaid Balance <br />of Assessment <br />( <br />1391.36 <br />349.67 <br />4696.40 <br />3778.32 <br />4399.21 <br />5477.20 <br />5516.31 <br />4891.15 <br />5813.16 <br />4713.69 <br />5688.70 <br />5074.97 <br />5381.58 <br />3829.62 <br />1705.53 <br />62706.87 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />26 -15 -2722 <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 -466, 1971 - 2 C.B. 409) Form 668(n(c) (Rev. 2 -2004) <br />Part 1 - Kept By Recording Office r•er nin ann,a,r <br />