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<br />........-------~......------._' <br /> <br />.-._---------------~~~-~-~~. <br /> <br />19j 003/004 <br /> <br />11/15/2005 17:03 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />200511291 <br /> <br />D <br /> <br />1872 <br /> <br />Department of the Treasury ~ Internal Revenue Service <br />, . <br /> <br />Notice of federal Tax Lien <br /> <br />For Optional Use by Recording Office <br />1~!lllrllllllll I . <br />i <br />i <br />9905422460-1 P;s: 1 I <br />MONtE MELTON L , <br />Filed: 11115/2005 11:15 AM J <br /> <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (800) 829-3903 257609805 <br /> <br />r As provided by secdon 632 t, 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 followlng~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 /> <br />Name of Taxpayer MELTON L MONIE <br /> <br />Residence <br /> <br />PO BOX 2583 <br />GRAND ISLAND, NE 68802-2583 <br /> <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 IRe 6325(a). <br /> <br />Kind of Tax <br />(a) <br />1040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2001 <br /> <br />Identifying Number <br />(c) <br />507-70-0995 <br /> <br />Date of <br />ASsessment <br />(d) <br />06/02/2005 <br /> <br />Last Day for <br />Refllmg <br />(e) <br />07/02/201.5 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />6860.74 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br /> <br />Total $ <br /> <br />6860.74 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />the <br /> <br />o 3-rd day of November <br /> <br />2005 <br /> <br />Signature /f / / Title <br />~aA/ Vt- f1~ ACS 29-00-000B <br />for S KILPATRICK (800) 829-3903 <br /> <br />(NOTE: Certificate 01 officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />~__, 0..1 "71_.d.RR 1971 _ 2 C.B. 409)' Form 668(Y)(C) (Rev. 2-2004) 0., <br />.. . ___ "__~~,,;,,,,'nffil''' CAT. NO 60025X' \ <br />