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<br />08/28/2006 13:17 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />IaI 006/006 <br /> <br />\J <br /> <br />200607725 <br /> <br />1872 <br /> <br />Form 668 (y)(C) <br />(Rev. February 20041 <br /> <br />Department of the Treasury - 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 310980806 <br /> <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are aIvIng a notice that taxes (Includinllnterest and penalties) <br />have been assessed against the foUowing-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 belonlin, to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accl1le. <br /> <br />Name of Taxpayer JEREMY E & ALISHA M CONROY <br /> <br />For Optional Use by Recording Office <br /> <br />,"- Nt Si... of '~.~o John AlIBI. . uee FTL '" <br /> <br /> <br />1188&467816-1 PIIS: 1 <br />CONROY RL.ISHA I'! <br />Filed: 08/21/2006 11:21 RI'! <br /> <br />Residence <br /> <br />'PO BOX 524 <br />WOOD RIVER, NE 68883-0524 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is retiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as e certificate of release' as defined <br />in IRC 6325(8). <br /> <br />Kind of Tax <br />a <br />1040 <br />1040 <br /> <br />Tax Period <br />EndinS <br />b) <br />12/31/2002 <br />12/31/2004 <br /> <br />Identifying Number <br />c <br />XXX-XX-4278 <br />XXX-XX-4278 <br /> <br />Date of <br />Assessment <br />(d) <br />06/30/2003 <br />05/30/2005 <br /> <br />Last Dq .for <br />Refiling <br />(e <br />07/30/2013 <br />06/29/2015 <br /> <br />Unpaid Balance <br />of Assessment <br />f <br />1364.16 <br />3704.80 <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 />5068.96 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />17th day of August <br /> <br />2006 <br /> <br />the <br /> <br />Signature <br /> <br />Title <br />ACS <br />for REGINA OWENS (800) 829-3903 <br />(NOTl: 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 668(Y)(c) (Rev. 2-2004) <br />Pan 1 . Kept By Recordbl. OBke CAT. NO 60025X <br /> <br /> <br />24-00-0008 <br /> <br />Q}J <br />