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03/16/2004 16:53 FAX 14024714429 NEBRASKA UCC <br />IA 006 /008 <br />F' <br />5347 <br />Form 668 (Y)(c) <br />Department of the Treasury - Internal Revenue Service <br />+Rev. February 2004) . <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA $#9 <br />Serial Number <br />For Optional Use by Recording Office <br />Lien Unit Phone: (651) 312 -6080 I <br />162237104 <br />M s.. <br />of. ss. +. - ucc Fn <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 />99®4323421 -7 Pps: t <br />BURRIS GARY M <br />Property belonging to this taxpayer for the amount of these taxes, and <br />Filed: 03/18/2004 01:00 PM <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer GARY M BURRIS <br />IMPERIAL CLEANERS AND LAUNDRY <br />200402570 <br />Residence 1927 N BROADWELL <br />GRAND ISLAND,,NE 68803 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column {e1, 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 Dayy for <br />Refilmg <br />unpaid Balance <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />e) <br />(f) <br />941 <br />06/30/1988 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />1203.97 <br />941 <br />09/30/1988 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />1853.31 <br />941 <br />03/31/1989 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />1824 <br />941 <br />06/30/1989 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />-23 <br />2251.08 <br />941 <br />09/30/1989 <br />47- 0707214 <br />05/10/1999 <br />_06/09/2009 <br />1708.17 <br />941 <br />12/31/1989 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />3423.37 <br />941 <br />03/31/1990 <br />47- 0707214 <br />09/13/1999 <br />10/13/2009 <br />2711.11 <br />941 <br />06/30/1990 <br />47- 0707214 <br />07/19/1999 <br />08/18/2009 <br />3351.55 <br />941 <br />09/30/1990 <br />47- 0707214 <br />07/19/1999 <br />08/18/2009 <br />3109.26 <br />941 <br />12/31/1990 <br />47- 0707214 <br />07/19/1999 <br />08/18/2009 <br />3426.62 <br />941 <br />03/31/1991_ <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2195.67 <br />941 <br />06/30/1991 <br />47- 0707214 <br />07/05/1999 <br />08/04/2009 <br />2555.49 <br />941 <br />09/30/1991 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2826.00 <br />941 <br />12/31/1991 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2256.79 <br />941 <br />12/31/1999 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />2223.62 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 36920.24 <br />Grand Island,' NE 68802 -1692 <br />This notice was prepared and signed at <br />the lath day of March <br />ST PAUL, MN <br />2004. <br />on this, <br />Signature Title <br />REVENUE OFFICER 29 -05 -1217 <br />'s <br />for MARY <br />�Q7;....��. r.��'� =� (712) 274 -173'5 <br />(NOTE: Certificate of- officer authorized �.y law to take acknowledgment is not essential to the validity of Nctice.of Fede L:Tax, lien <br />Rev. Rul. 71-466.1971 - 2 C.B. 4091 '•r _ .' zs., ,.::.`,' . _ .• <br />