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Jan. 22. 2018 3:04FM NE 'Secretary <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #6 <br />Lien Unit Phone: (800) 913 -6050 <br />Name of Taxpayer TORY M SEMM <br />Residence <br />Kind of Tax <br />(a) <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 />6672 <br />Place of Filing <br />Signature <br />for COLS <br />Tax Period <br />Ending <br />(b) <br />06/30/2008 <br />09/30/2008 <br />12/31/2008 <br />03/31/2009 <br />06/30/2009 <br />09/30/2009 <br />12/31/2009 <br />03/31/2010 <br />06/30/2010 <br />09/30/2010 <br />12/31/2010 <br />03/31/2011 <br />06/30/2011 <br />09/30/2011 <br />12/31/2011 <br />CHWAN <br />11874 <br />the 22nd day of December 2017 <br />State - UCC Na, 3304 F. 4/6 <br />Department of the Treasury - internal Revenue Service <br />Notice of Federal Tax Lien <br />Identifying Number <br />(c) <br />XXX -XX 8 9 61 <br />XXX -XX -8961 <br />XXX -XX- 8 9 61 <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 />12 <br />1 2 / 1 4 / 2 0 1 5 <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 />291004517 <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 />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (el, this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 0325(a). <br />Last Day for <br />Refiling <br />(e) <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 />01/13/2026 <br />Title <br />REVENUE OFFICER <br />(402) 473-4671 <br />Total $ <br />201900435 <br />For Optional Use by Recording Office <br />N! sec of si John a bale - UGe alt <br />hi I <br />II <br />i I <br />9916804803 -6 Psa: 1 <br />6EMM TORY M <br />Filed: 01/22/2019 19:51 AM <br />(f) <br />Unpaid Balance <br />of Assessment . <br />2356.42 <br />2428.87 <br />2940.47 <br />2027.42 <br />1572.58 <br />1518.31 <br />1647.74 <br />2101.19 <br />4370.98 <br />5518.48 <br />6634.48 <br />9685.94 <br />15553.60 <br />14581.52 <br />15927.93 <br />88865.93 <br />This notice was prepared and signed at CHICAGO, z1 ' , 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) <br />Form 666(Y)(c) (Rev_ 2 -2004) <br />Part 1 Kept By Recording Office ('at kin crn-ic V \� A <br />