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08/19/2005 10:24 FAX 14024714429 NEBRASKA UCC <br />11% <br />Farm 668 (Y)(c) <br />(Rev. February 2004) <br />200508162 <br />1872 - <br />Department of the Treasury Internal Revenue Service . <br />Notice of Federal Tax Lien <br />Area: Serial Number <br />WAGE & INVESTMENT AREA #(:5 <br />Lien Unit Phone: (800) 829 -7650 242591605 <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 LUARCA PEREZ <br />Residence 401-W KOENIG ST <br />GRAND ISLAND, NE 68801 -6515 <br />11002/002 <br />For Optional Use by Recording Office <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 />an the day following such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />Tax Period -Date of Last Day for <br />Kind of Tax Ending Identifying Number Assessment Refiling <br />(a) I I (b) c d (e <br />NQ 6ac of 64416 -UGC 6TL <br />I <br />I <br />I <br />I <br />!M5"'0e2 -a pas: 1 <br />PERE2 DOMINGO LURRCA <br />Filyd: e8/18/2005 04.29 PM <br />1040 112/31/19971 621 -62 -0025 109/20/20041 10/20/2014 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 10th day of August <br />4016161 <br />ST PAUL, MN <br />Unpaid Balance <br />of Assessment <br />5377.62 <br />Total 1$ 5377.62 <br />, on this, <br />Signature ACS 15 -00 -0000 <br />for WANDA W. BROWN (800) 829 -7650 <br />(NOTF: 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) Form b68(Y)(c) (Rev. 2 -2004) <br />a.— * . Q... rva Sandce TDA CaDv PAT Mr) Fir1rl9Fx <br />