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05/02/2002 17:02 FAX 14024714429 NEBRASKA UCC <br />109 <br />Department of the Treasury - Internal Revenue Service <br />Form 66B (Y)(c) Nonce of Federal Tax Lien <br />(Rev. October 2000) <br />Area: Serial Number For Option <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 <br />Uen Unit Phone: (800) '829-3903 390256364 i <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 folkwAn"amed 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 al 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 HECTOR ERIVES- DOMINGUEZ <br />Residence PO BOX 502 <br />GRAND ISLAND, NE 68802 -0502 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (a), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(x). <br />Tax Period Date of Last D for <br />Kind of Tax Ending Identifying Number Assessment Refii V <br />1040 112/31/1999 <br />1040 12/31/2000 <br />Place of Filing <br />al Use <br />Q003/003 <br />Office <br />FTC <br />1 <br />FRS <br />c d e <br />505 -35 -9010 06/04/2001 07/04/2011 <br />505 -35 -9010 12/31/2001 01/30/2012 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 26th day of April <br />2002 <br />MILWAUKEE, WI <br />200204855 <br />Total 1$ <br />Unpaid Balance <br />of Assessment <br />9333.64 <br />2639.96 <br />11973.60 <br />, on this, <br />Signature f <br />^A� iu-v� � �"'a —` Acs 27 -00 -0008 <br />for J c L ER (800) 829 -3903 <br />tnvrs: lRrUncaTe of ornce; euL11U1I a uy yaw -- -- - -" .., .n... ....- .. -- - - -- -- - -- - - -• - - - - - -- - - <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 409) Form 666(Y)(c) (Rev. 10-00) <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />