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r; <br />03/16/2004 16:54 FAX 14024714429 NEBRASKA UCC Q007/008 <br />5347 <br />Department of the Treasury Internal Revenue Service <br />Form 668 (Y)(c) Notice of Federal Tax Lien <br />(Rev. February 2004) <br />Area: Serial Number For Optional Use by Recording Office <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 Nc sa of S4.40 -UCC FTL <br />Lien Unit Phone: (651) 312 -8080 162237804 <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, 111111111 11111111 1 1 1 fill 111111111111111111[ <br />there is a lien in favor of the United States on all property and rights to 9904323423 -I PosBURRIS GARY M <br />property belonging to this taxpayer for the amount of these taxes, and Filed: 0311612004 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 />Residence 1927 N BROADWELL (► �j C�J <br />GRAND ISLAND, NE 68803 <br />2 0 4 4 k+ <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column <br />(e), this notice shall, <br />on the day following such date, <br />operate as a certificate of release as <br />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 />Refling <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(i <br />6723 <br />12/31/1999 <br />47- 0707214 <br />12/09/2002 <br />01/08/2013 <br />1281.73 <br />940 <br />12/31/1990 <br />47- 0707214 <br />09/06/1999 <br />10/06/2009 <br />325 -95 <br />940 <br />12/31/1993 <br />47- 0707214 <br />05/17/1999 <br />06/16/2009 <br />350.21 <br />940 <br />12/31/1994 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />398.97 <br />940 <br />12/31/1995 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />357.73 <br />940 <br />12/31/1996 <br />47- 0707214 <br />05/17/1999 <br />06/16/2009 <br />359.00 <br />940 <br />12/31/1997 <br />47- 0707214 <br />05/17/1999 <br />06/16/2009 <br />300.69 <br />940 <br />12/31/1998 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />133.61 <br />940 <br />12/31/2000 <br />47- 0707214 <br />04/20/2001 <br />05/20/2011 <br />17.99 <br />Place of Filing <br />Register Of Deeds <br />Hall POBOX 1692 Total $ 3525.88 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN on this, <br />lf. <br />r <br />the <br />11th day of March. 2004 <br />•.J <br />Signature a e,:.� °"° r p Title <br />Si <br />g e ey �y'% ;,, s ,d. REVENUE OFFICER 29 -05 -1217 <br />for MARY MORGAN ;. (712) 274 -1735: <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul- 71-466,1971 - 2 C.B. 409.1'- Form 668(Y)(c) (Rev. 2 -2004) <br />