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02/04/2004 12:17 FAX 14024714429 NEBRASKA UCC <br />r� <br />, <br />v <br />1008 <br />Department of the Treasury - Internal Revenue Service <br />Form 668 (Y)(c) <br />IRev. October 2000) Notice of Federal Tax Lien <br />U002/004 <br />Area: <br />Serial Number <br />For Optional Use by Recording Office <br />WAGE & INVESTMENT AREA #5 <br />Lien Unit Phone: (a00) 829 -7650 <br />153477604 <br />AIR S— of sisi• - uce pn <br />As provided by section 6324, 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 />! <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 />i <br />property belonging to this taxpayer for the amount of these taxes, and <br />9904313391 -2 Pas: 1 <br />MLINA sIGIFI ED0 <br />additional penalties, interest, and costs that may accrue. <br />Filed: 01130/2a04 09:18 fiM <br />Name of Taxpayer S I GI FREDO MOLINA <br />Residence 512 O NEILL CIR <br />GRAND I SLAND , NE 68801-7149 <br />2 0 0 4 01 U Ls S <br />V <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 />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refiling <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />1040 <br />12/31/1999 <br />507 -23 -9050 <br />04/15/2000 <br />05/15/2010 <br />1040 <br />12/31/1999 <br />507 -23 -9050 <br />04/22/2002 <br />05/22/2012 <br />8233.67 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 8233.67 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 27th day of January <br />2004 <br />ST PAUL, MN <br />on this, <br />Signature' Title <br />ACS 15 -00 -0000 <br />for WANDA WHr`BRDWN' ` •� "S Fh'� °= 'fir• -� .(800) B29 -7650 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of "Clerai i ax lien <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 409) Form 668(X)(c) (Rev. 10 -00) <br />