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<br />01/09/2007 TUE 16:54 FAX 402 471 2530 secofstate/licensing div <br /> <br />~ 002/006 <br /> <br />\7 <br /> <br />1075 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />200700221 <br /> <br />Form 668 (Y)(c) <br />(Rev. Februilry 20041 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF.EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-60S0 324240606 <br /> <br />As provided by se<<ion 6321J1 6322J1 and 6323 of the Internal R.evenue <br />CodeJl we are giving a notice that tax~ (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. ThereforeJl <br />there is a Den in favor of the United States on all property and rights to <br />propertY belonpng to this taxpayer for the amount of these taXesJI and <br />additional penaltiesJl interest, and costs that may accrue. <br /> <br />Name of Taxpayer JIM K KEESHAN <br /> <br />For Optional Use by Recording Office <br /> <br />. \1~~I'IIIIII'I\I\~nl <br /> <br /> <br />9907489153-3 PgI: 1 <br />KEESHAN JIM K <br />Filed: 01fm~f2007 0~:50 PM <br /> <br />Residence <br /> <br />3860 W AIRPORT RD <br />GRAND ISLAND, NE 68803-9705 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refilcd 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 I.RC 6325(01). <br /> <br />Kind of Tax <br />(a) <br />1.040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2004 <br /> <br />Identifying Number <br />(e) <br />XXX-XX-1420 <br /> <br />Date of <br />Assessment <br />(d) <br />07/24/2006 <br /> <br />Last Day for <br />Rardina <br />.(e) <br />08/23/2016 <br /> <br />Unpaid Balance <br />of Assessment <br />.. (f) <br />726.79 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-l692 <br /> <br />Total $ <br /> <br />726.79 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL t MN <br /> <br />, on this, <br /> <br />the <br /> <br />24th day of October <br /> <br />2006 <br /> <br />, . <br /> <br />Signature <br /> <br />Title <br />'REVENUE OFFICER <br />for KAY PONTE (308) 384-4850 <br />(NOTE: Certificate of officer Oluthorizlld by liilw to take acknowl&dgmcnt is not Qsscntial to the validity of Notice of Federal Tax.lien i-'~ <br />Rev. RLlI. 71-466,1971 - 2 C.B. 4091 Form 668m(c) (Rev. 2-2004)" ..I <br />Pan 1 - Kept By Recordinr Offi~ CAT. NO 60Q25X .... ! <br /> <br /> <br />24-:1.0-2339 <br />