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07/22/2003 08:35 FAX 14024714429 NEBRASKA CICC <br />1 1008 <br />Form b6 B (Y) (c) Department of the Treasury - Internal Revenue Service <br />(Rev. Octobe, 2000) 1 Notice of Federal Tax Lien <br />Area: Serial Number <br />SMALL BUSINESS /SELF EMPLOYED AREA 09 <br />Lien Unit Phone: (651) 312 -6000 124548803 <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 NICKIE J KALLOS <br />Z003/003 <br />For Optional use by Recording Office <br />N[ Sac of 61649 - ucc RTL <br />9963286604-7 Poe: <br />KRLL05 NICKIE J <br />Filed: 0712112003 03:19 PM <br />Residence 516 E PLUM ST 200309430 <br />GRAND ISIIAND, NE 68801 -5910 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refdad 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 Dayy for <br />Refiiing <br />Unpaid Balance <br />of Assessment <br />(a) <br />b <br />(c) <br />(d) <br />(e) <br />(f) <br />940 <br />12/31/2002 <br />47- 0395808 <br />03/17/2003 <br />04/16/2013 <br />92.06 <br />941 <br />03/31/2002 <br />47- 0395808 <br />12/23/2002 <br />01/22/2013 <br />593.09 <br />941 <br />06/30/2002 <br />47- 0395808 <br />12/09/2002 <br />Cl/C8/2013 <br />1051.69 <br />941 <br />09/30/2002 <br />47- 0395808 <br />04/07/2003 <br />05/07/2013 <br />1394.05 <br />941 <br />12/31/2002 <br />47- 0395808 <br />04/07/2003 <br />05/07/2013 <br />1204.46 <br />Place of Filing <br />Register of Deeds <br />Hall P030X 1692 Total <br />$ 433S-35 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PATJL, M <br />on this, <br />the 17th day of July 2003 <br />Sionature <br />Title <br />REVENUE OFFICER <br />29 -10-2339 <br />fcr KAY <br />(308) 384 -6667 <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. 1 71 -466, 1971 - 2 C.B. 409) <br />Form 668(Y)(e) (Rev, 10 -00) <br />Part 1 - Kent By Recording Office <br />. _ .,,..>,.,.1, <br />1r <br />e <br />