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<br />01/30/2007 18:04 FAX 14024714429 <br /> <br />NEBRASKA DCC <br /> <br />IaI 0021003 <br /> <br />~ <br /> <br />12414 <br /> <br />Department of the Treasury ~ I~ternal Revenue Service <br />-Notice of Federal Tax Lien <br /> <br />200700775 <br /> <br />Form 668 (Y)(C) <br />(Rev, FebruafY 2004) <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED'AREA #4 <br />Lien Unit Phone: (800) 913-6050 3:40462407 <br /> <br />As provided-by seCtion 6321, 6322, and 6323 of the Intem~1 Revenue <br />Code, we are giving a notice that taxes (including interest and ipenalties) <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 aU property ana 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, PEDRO CRUZ ' <br /> <br />For Optionaf Use by Recording Office <br /> <br />\111\11111' <br /> <br /> <br />9907493017-1 Pgs. 1 <br />CRUZ PEDRO <br />Filed: 0113012007 10,18 AM <br /> <br />Residence <br /> <br />401 EAST 7TH STREET <br />GRAND ISLAND., NE 68801-0000 <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 IRe 6325(a). ! <br /> <br />Kind of Tax <br />(a) <br />1040 <br /> <br />Tax Period <br />Ending <br />(bl <br />12/31/2003 <br /> <br />Identifying Number <br />(c) <br />XXX-XX-2135, <br /> <br />Date of! <br />Assessment <br />Cd) ! <br />08/29/20:05 <br /> <br />Last Day for <br />Refilinr <br />(e) . <br />09/28/2015 <br /> <br />Unpaid Balance <br />of Assessment <br />CO <br />10298.17 <br /> <br />'- <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 />10298.17 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />the <br /> <br />18 th day of January <br /> <br />2007 <br /> <br />for CLAIRE M NICHOLAS <br /> <br /> <br />Title: <br />TXPYR RES REP <br />(30lin 532-7511 <br /> <br />14-02-1408 <br /> <br />Signature <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment i~ not essential to the validity of Notice of Federal Tax lien' <br />Rev. Rut 71-466, 1971 - 2 C.B. 409) , Fonn 668(Y)(c) (Rev. 2-2004) <br />Part 1 . Kept By RecordlllS Office CAT, NO 60025X <br /> <br />CP <br />