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6 Feb, 6. 2010 3:53FM NE Se retary of State <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 />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 WARREN J KIRSH <br />Residence <br />the <br />IMPORTANT RELEASE INIFORMATION: For each assessment listed below, <br />unless notice of the lien is raffled by the date given In column (a), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 8325(a). <br />Kind of Tax <br />(a) <br />1040 <br />6672 <br />6672 <br />6672 <br />Place of Filing <br />Signature <br />for DANI <br />1201 ALLEN DR #101 <br />GRAND ISLAND, NE 68803 -0000 <br />Tax Period <br />Ending <br />(b) <br />11874 <br />12/3112010 <br />06/30/2016 <br />09/30/2016 <br />12 <br />This notice was prepared and signed at <br />17th day of January - 2018 <br />E L PLATT <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Date of <br />Identifying Number Assessment <br />(c) , (d) <br />XXX - XX - 3651 <br />XXX - XX - 3651 <br />XXX XX 3651 <br />XXX - XX - 3651 <br />Serial Number <br />11/26/2012 <br />11/27/2017 <br />1 <br />11/27/2017 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />CHICAGO, IL <br />Part t - Kept By Recording Office <br />293575638 <br />Last Re for <br />lliing <br />(e) <br />12/26/2022 <br />12/27/2027 <br />12/27/2027 <br />12/27/2027 <br />I Title - <br />REVENUE OFFICER <br />(402) 473 -4675 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 409) <br />No. 0069 <br />For Optional Use by,Recordin9 Off co <br />NW Sae of i4a4s John 11 dale - UCC TTL <br />9918805655 -4 Pgs: 1 <br />KIRSH WARREN J <br />Filed: 02/06/2018 el :24 P11 <br />201800 17 <br />Unpaid Balance <br />of Assessment <br />(f) ..:� <br />65.86 <br />5693.69 <br />4825.05 <br />5211.60 <br />Total $ 15796.20 <br />, on this, <br />26 -15 -2720 <br />of Notice of Federal Tax lien <br />Form 666(Y)(c) (Rev. 2-2004 <br />CAT. NO 60025X <br />