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<br />05/10/2006 13:30 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ <br /> <br />141011 <br /> <br />18.72 <br /> <br />200604148 <br /> <br />Form 668 (Y){C) <br />(Rev. February 2004) <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />Area: Serial Number <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone: (800) 829-7650 287221606 <br /> <br />A5 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 penalti,es, interest, and costs that may accrue. <br /> <br />Name of Taxpayer ENCARNACION LOPEZ AMBROCIO <br /> <br />Residence <br /> <br />311 E 3RD ST <br />GRAND ISLAND, NE 68801-7717 <br /> <br />IMPORTANT RELEASE IN.FORMATlON: 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 />For Optional Use by Recording Office <br /> <br />1111"1111"111111'11 <br /> <br />~~~~~lg5~~i~~~~~Ig~ ,~gp~f: 1 <br /> <br />Kind of Tax <br />(a) <br />1040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/1997 <br /> <br />Identifying Number <br />(c) <br />XXX-XX-9140 <br /> <br />Date of <br />Assessment <br />(d) <br />04/04/2005 <br /> <br />Last Day for <br />Refiling <br />(el <br />05/04/2015 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />. 17967.23 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692' <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />Title <br />ACS <br />for DEBRA K. HURST (800) 829--7650 <br /> <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. Ru1. 71-466, 1971 - 2 C.B. 409) Form 66B(Y)(c) (Rev. 2-20041 <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br /> <br />the <br /> <br />27th day of April <br /> <br />2006 <br /> <br />Signature <br /> <br /> <br />Total $ <br /> <br />17967.23 <br /> <br />12-00-0000 <br /> <br />~ <br />