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<br />06/20/2006 16 :06 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />14J 0021002 <br /> <br />200605541 <br /> <br />~ <br /> <br />\J Form 668 ,(Y){C) <br />(Rev. February 2004) <br /> <br />1872 <br /> <br />Department of the Tr~asury - Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />Area: . Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 296460406 <br /> <br />A5 provided, by section 6321, 6322, and 6323 of the 'Internal Revenue <br />Code, we are giving a notice tbat 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 /> <br />Name of Taxpayer JOSE HERNANDEZ <br /> <br />For Optional Use by Recording Office <br /> <br /> <br />9906457888-0 P9S' 1 <br />HERNRNDEZ JOSE . <br />FU_,d, ,06/20/2006 10:20 AI'l <br /> <br />Residence <br /> <br />604 E MEMORIAL DR <br />GRAND ISLAND, NE 68801-7856 <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 IRC 6325(a). <br /> <br />Kind of Tax <br />(a <br />1040 <br /> <br />Tax Period <br />Ending <br />(b <br />12/31/2002 <br /> <br />Identifying Number <br />(c) <br />XXX-XX-8315 <br /> <br />Date of <br />Assessment <br />(d <br />07/25/2005 <br /> <br />Last Day for <br />Refiling <br />(e) <br />08/24/2015 <br /> <br />Unpaid Balance <br />.of Assessment <br />(f) <br />18284.81 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Islandr NE 68802-1692 <br /> <br />Total $ <br /> <br />18284.81 <br /> <br />This notice was prepared an~ signed a,t . <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />the <br /> <br />09th day of June <br /> <br />2006 <br /> <br />Signature <br /> <br /> <br />Title <br />ACS <br />(800) 829-3903 <br /> <br />24-00-0008 <br /> <br />for REGINA OWENS <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien ~r\ <br /> <br />Rev. Rul. 71-466, 1971 - Z C.B. 409) Iou ffi Form 668(Y)(c) (Rev. 2-2004) ..' tJ <br />Part 1 . Kept By ~ordlnl 0 Ice CAT. NO 60025X <br />