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<br />10/11/2006 08:31 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />Igj 0021002 <br /> <br />@ <br /> <br />Form 668 (Y)( c) <br />(II!!\{. February 20041 <br /> <br />1075 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of-federal Tax Lien <br /> <br />Area: Serial Number <br />SMALL BUSINSSS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 319902906 <br /> <br />As provided by section 6]21, 6322, and 6323 of the Internal Revenue <br />Code, we are givin, 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 Uability, 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 TOL <br /> <br />For Optional Use bv Recoraing Office <br /> <br /> <br />9986474883-5 PSIS: 1 <br />Tal JOSE <br />Filed: 10/10/2006 08:52 ~ <br /> <br />Residence <br /> <br />412 ELM ST <br />GRAND ISLANDr NE 68801 <br /> <br />200609069 <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 a~ defined <br />in IRe 6325(a). <br /> <br />Kind of Tax <br />(a) <br />1040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/199'7 <br /> <br />Identifying Number <br />(e) <br />XXX-XX-0844 <br /> <br />Date of <br />Assessment <br />(d) <br />09/20/2004 <br /> <br />Last Day for <br />Refiling <br />e) <br />10/20/2014 <br /> <br />Unpaid Balance <br />of Assessment <br />f <br />8652.00 <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 />8652.00 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAULr MN <br /> <br />, on this, <br /> <br />. the <br /> <br />28th day of <br /> <br />September 2006 <br />, <br /> <br />Signature <br /> <br /> <br />Title <br />ACS <br />(800) 829-7650 <br /> <br />14-00-0000' <br /> <br />for R. RAY JOHNSON <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax l1en <br />Rev. Rul. 71-466, 1971 - 2 C.B. 4091 Form 668(Y)(c) (Rev. 2.-2004) <br />Part 1 - Kept By Recording Ofttce CAT. NO 60025X of) <br />