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<br />01123/2007 17: 21.,.FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 0021003 <br /> <br />~ <br /> <br />Form 668 (Y)(c) <br />IRev. February 2004) <br /> <br />200700575" <br /> <br />1671 <br /> <br />Department of the Treasury - Internal Revenue Service <br /> <br />Notice of Federal Tax Lien <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (80'0) 913-6050 ,339006807 <br /> <br />As 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 IlabUity, but it remains unpaid. Therefore, <br />there is a lien in favor of the United States on all property an,d rights to <br />property belonging to tbls taxpayer for tbe amount of these taxes, and <br />additional penalties, interest, and costs tbat may accrue. <br /> <br />Name of Taxpayer RAFAEL J MONTELONGO <br /> <br />For Optional Use by Recording Office <br /> <br />\11111111' <br /> <br /> <br />9907491614-5 PSIS, 1 <br />MONTELONGO RAFAEL J <br />Filed, 0112312007 08:29 AM <br /> <br />Residence <br /> <br />2314 GEORGE ST APT' 3 <br />GRAND ISLAND, NE 68803-4729 <br /> <br />IMPORTANT RELEASE INFORMATION: For each ~ssessmBnt listed below, <br />unless notice of the lien is refiled by the date given in column (6), 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 /> Tax Period Date of Last D"lnfor <br />Kind of Tax Ending Idendfying Number Assessment kefi 'g <br />(a) (b) (el (d) (e) <br />1040 12/31/2000 XXX-XX-1023 03/21/2005 04/20/2015 <br />1040 12/31/2001 XXX-XX-1023 03/21/2005 04/20/2015 <br />1040 12/31/2002 XXX-XX-1023 OS/29/2006 06/28/2016 <br />1040 12/31/2003 XXX-XX-I023 OS/29/2006 06/28/2016 <br /> <br />Un paid Balance <br />of Assessment - <br />(f) <br />30895.18 <br />57019.47 <br />6893,3.08 <br />146164.70 <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 />303012.43 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />the <br /> <br />12 th day of January <br /> <br />2007 <br /> <br />r <br /> <br />Signature !J'... II., 'yn. ~/, IJ! <br />for MICHAEL W PONTE <br /> <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br /> <br />24-10-2337 <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice I f Federal Tax lien <br />Rev. Rul. 71-466,1971 - 2 C.B. 4091 Form 661 (Y)(c) (Rev. 2-2004l n, ()\_,'" <br />Part 1 - Kept By Recording Omce CAT. NO 60025X \. .l>i <br />