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03/16/2004 16:52 FAX 14024714429 NEBRASKA UCC IA 005/008 <br />r <br />i i tJ <br />U — <br />Form 668 (Y)(c) <br />Department of the Treasury - Internal Revenue Service <br />Wev. February 2004) Notice of Federal Tax Lien <br />Hrea: Serial Number <br />SMALL BUSINESS /SELF EMPLOYED AREA 49 <br />Lien Unit Phone: (651) 312 -8080 162236704 <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 />Vame of Taxpayer GARY M BURRIS <br />IMPERIAL CLEANERS AND LAUNDRY <br />For Optional Use by Recordinq Office <br />ss043; <br />BURRIS <br />Filed: <br />FTL <br />Par: I <br />01:00 PM <br />Residence 1927 N BROADWELL <br />GRAND I S LAND , NE 68803 <br />200402569 <br />WEE <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 />Tax Period <br />Ending <br />Identifying Number <br />Date of <br />Assessment <br />Last Day for <br />Refiling <br />unpaid Balance <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />941 <br />03/31/1992 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2210.82 <br />941 <br />06/30/1992 <br />47- 0707214 <br />05/17/1999 <br />06/16/2009 <br />2084.02 <br />941 <br />09/30/1992 <br />47- 0707214 <br />05/17/1999 <br />06/16/2009 <br />2850.11 <br />941 <br />12/31/1992 <br />47- 0707214 <br />07/19/1999 <br />08/18/2009 <br />2773.21 <br />941 <br />03/31/1993 <br />47- 0707214 <br />05/10/1999 <br />0610912009 <br />2437.08 <br />941 <br />06/30/1993 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />3594.99 <br />941 <br />12/31/1993 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2763.75 <br />941 <br />03/31/1994 <br />47- 0707214 <br />08/02/1999 <br />09/01/2009 <br />2049.75 <br />941 <br />06/30/1994 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2613.30 <br />941 <br />09/30/1994 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />3118.46 <br />941 <br />.12/31/1994 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />3383.86 <br />941 <br />03/31/1995 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2416.21 <br />941 <br />06/30/1995 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2590.18 <br />941 <br />09/30/1995 <br />47- 0707214 <br />07/19/1999 <br />08/18/2009 <br />2366.61 <br />941 <br />09/30/1999 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2595.59 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 3.9,847-94 <br />Grand Island, NF 68802" -1692 <br />This notice was prepared and signed at ST PAUL, MN <br />on this, <br />the 11th day of March 2 0 04 <br />Signature ..s r, v =fi�wg} yrs! Title <br />AA' ' <br />'m�h.at . <br />REVENUE OFFICER 29 -05 -1217 � <br />for MARY MORGAN (712) 274 -1735 <br />(NOTE: Certificate of officer authorized by jaw to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />L <br />Rev..Rul. 71 -466, 1971 - 2 C.B. 409) <br />