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05/05/2004 16:59 FAX 14024714429 NEBRASKA UCC <br />IM 003/001 <br />200404514 <br />r <br />1008 <br />Department of the Treasury - Internal Revenue Service <br />Form 668 (ln(c) <br />(Rev. February 2004) Notice of Federal Tax Lien <br />Area: Serial Number For Optional Use by Recording Office <br />WAGE & INVESTMENT AREA #5 <br />Lien Unit Phone: (800) 829 -7650 i 169785004 <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 DOMINGO TERCERO RAMIREZ <br />AKA DOMINGO TERCERO <br />Residence 120 E CHARLES <br />GRAND ISLAND, NE 68801 -6019 <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 />Nt See of <br />Tax Period Date of Last Da for <br />Kind of Tax Ending Identifying Number Assessment RefIL9 <br />1040 <br />12/31/1993 <br />1040 <br />12/31/1998 <br />1040 <br />12/31/1999 <br />1040 <br />12/31/2000 <br />1040 <br />12/31/2001 <br />Place of Filing <br />(c) (d) <br />590 -08 -0154 <br />09/16/1996 <br />590 -08 -0154 <br />07/14/2003 <br />590 -08 -0154 <br />07/07/2003 <br />590 -08 -0154 <br />07/14/2003 <br />590 -08 -0154 <br />07/21/2003 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN <br />the 27th day of APril 2004 <br />Signature <br />for WANDA W_ BROWN <br />(NOTE: Certificate of officer authorized by law to take ack <br />o••1 -71_e.aa 1871 - 2 C.B. 409) <br />(e) <br />10/16/2006 <br />08/13/2013 <br />08/06/2013 <br />08/13/2013 <br />08/20/2013 <br />Total 1$ <br />Unpaid Balance <br />of Assessment <br />456.10 <br />1461.39 <br />4806.42 <br />12784.22 <br />1778.41 <br />21286.54 <br />, on this, <br />Title <br />ACS 15 -00 -0000 <br />(80 0) 829 -7650 <br />nowledgment is not essential to the validity of Notice of Federal Tax lien <br />Form 668(Y)(c) (Rev. 2 -2004) <br />