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Mar. 23.2019 3:47AM NE __:rotary f Stat: — UCC <br />.O61290E179I <br />NE Sia nrS,mc- Rebut 3l.. &nen <br />Filing Document A:1903001428-4 Pages: 1 <br />Oehler Na,,e: TOMS DELIVERY SERVICE INC A CORPORA <br />Fillet Dab and Time: OVA2029 02:31 PM <br />Form 668 (Y)(c) <br />(Rev, FeQrlu, 2(447Notice <br />3351 <br />Department of the Treasury - Internal Revenue Service <br />of Federal Tax Lien <br />Area: <br />SHALL 6.0SI)-F;SS/SELF' EMFLOYED AREA 86 <br />Lien Unit Phone: (000) 913-6050 <br />Serial Number <br />347324019 <br />For optional Use by Recording Office <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 TOMS DELIVERY SERVICE INC <br />a Corporation <br />Residence 2407 W 4TH ST <br />GRAND ISLAND, NB 68803-4507 <br />IMPORTANT RELEASE INFORMATION; For each assessMent listed below, <br />unless notice of the lien is Wiled by the date given in column (el, this notice shall, <br />on the day ollowing such date, operate se a certificate of release as defined <br />in 1RC 6325la1.. <br />Kind of Tax <br />(<a) <br />Tax Period <br />Ending <br />(b) <br />Identifying Number <br />(c) <br />Date of <br />Assessment <br />(d) <br />last Day for <br />Refiling <br />(e) <br />Unpaid Balance <br />of Assessment <br />(f) <br />941 <br />941 <br />06/30/2018 <br />09/30/2018 <br />XX-XXX6303 <br />XX-XXX6303 <br />09/24/2018 <br />01/14/2019 <br />10/24/2028 <br />02/13/2029 <br />3393.54 <br />456-33 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand IB1and, NE 68802-1692 <br />$ 3849.87 <br />This notice was prepared and signed at CHICAGO, IL <br />the 19th day of March <br />2019 <br />, on this, <br />Signature Title <br />REVENUE OFFICER <br />for COLE cHwAN• (402) 473-4671 <br />26-15-2722 <br />(NOTE: Certificate of officer authorized oy'e0r to Wks acknowledgment is not asaentlel to the validity of Make of Federel Tax lien <br />Rev. 6u1. 71-466, 1971 - 2 G.B, 4091 <br />Pan I - Kept ay Recordlnt Office <br />Form 66e(Y)(C) (Rev. 2-2004) <br />CAT. NO 60025X <br />