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Jan, 22. 2013 3:05PNI NE Secretary of State — UCC No. 3304 P. 5'6 <br />Form 668 (Y)(c) <br />(Rev. February 2004) <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 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 />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />6672 <br />• Place of Filing <br />the 22nd day of December 2017 <br />Signature <br />for COLB <br />4174 ARIZONA AVE <br />GRAND ISLAND, NE 68803 -1110 <br />Tax Period <br />Ending <br />(b) <br />CHWAN <br />11874 <br />03/31/2012 <br />0 <br />09/30/2012 <br />12 <br />03/31/2013 <br />06/30/2013 <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 -XX -8961 <br />xxX -XX -8961 <br />XXX -XX -8961 <br />xxx -XX -8961 <br />Serial Number <br />Date of <br />Assessment <br />(d) <br />12/14/2015 <br />1 <br />12/14/2015 <br />12/14/ <br />1 2/14/2 0 15 <br />12/14/2015 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />291004617 <br />Last Day for <br />Reflling <br />(e) <br />01/13/2026 <br />01/13/2026 <br />01/13/2026 <br />01/ <br />01/13/2026 <br />01/13/2026 <br />Title <br />REVENUE OFFICER <br />(402) 473 -4671 <br />20180043E <br />For Optional Use by Recording Office <br />NI Sae of Stain John IN Gala UCC FTL <br />I I II <br />I I <br />9916604604 -0 Pas: 1 <br />SEMM TORY II <br />Filed: 011221201 10:57 RM <br />Total $ <br />Unpaid Balance <br />of Assessment <br />(f) <br />12889.59 <br />15 511.72 <br />13520.14 <br />13340.43 <br />8715.08 <br />11272.44 <br />75249.40 <br />This notice was prepared and signed at CHICAGO IL , on this, <br />26 -15 -2722 <br />(NOTE: Certificate of officer authorized bylaw 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 669(Y)(c) (Rev. 2 -2004) <br />Part I - Kept By Recording Office raT tan F.nn7RY <br />