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<br />~ <br />~ <br /> <br />I <br /> <br />I <br /> <br />Form 668{Y) <br /> <br />2 5 Departmllnl ollhe Treaeury . Inlernal RsvenUll Service <br /> <br />(Rey, December 1985) <br /> <br />Notice-of Federal Tax Lien Under Internal Revenue Laws <br />. I .. - <br /> <br /> , <br />District Serial Number For Optlonsl U,. by RlICOI'dlng Offlco <br /> Omaha, NE 478800985 <br />AI provided by sectlQna 6321, 8322, and 8323 of the Internal Revenue Code, <br />notice II given that tlltes (Including 'Intereat and ponaltl..) have boen 100833 <br />a...lsed agllnlt Ihe following-named taxpllyer. Demand for pay men I of 88- <br />Ihl. lIablll~ haG been nlade, buill remains unpaid. Thorefore, Iher. Is II lion <br />In favor of he United S(al88 on all procrty and rlghtll to pro~erty belonging <br />to thla taxpayer for Ihe amount of I ele'lax.l, end addU onal penal tie., <br />Inler8,1, and cOl18 Ihalmay accrue, <br />Name of Taxpayer JAMES & JUDY SAMPLE <br />Residence <br /> 104 S. 16TH ST, BOX 63 <br /> AURORA, NE 68818 <br />IMPORTANT RELEASE INFOFiMATlON: Wilh respecllo each assessmenlllsled below, unless <br />notice of lien 18 rellled by the date given in column (e), this notice shall, on the day following <br />such date. operate as a certificate of release as defined in IRC 6325(a). <br /> . <br /> To Period Date of Lalt Day for Unpaid Balan!:. <br />Kind of Tax Ended Identifying Number Asaenment Reflllng of AI.e.lment <br />" (Ii) (b) (c) (d) (e) (f) <br />- 1040 12-31-85 506-58-5945 6-02-86 7-02-92 471.69 <br /> 1040 12-31-86 506-58-5945 5-18-87 6-17-93 2491.07 <br />- <br />Place of Filing Register of Deeds <br /> Hall County Total $ 2962.76 <br /> Grand Island, NE 68801 <br /> <br />This notice was prepared and signed at <br /> <br />Omaha, NE <br /> <br />. on this, <br /> <br />10th February 88 <br />the day of , 19 <br /> <br />~ ,"'1 //) <br />" ,,',~ " ," /,"./1.0 Title <br />..rt? ids,> P h () n e -'-1-'Ls {}1)::::"2'i r - 5 3 8 <br />47-01-0000 <br /> <br />Signature <br /> <br /> <br /> <br />Revenue Officer <br /> <br />(NOTE: Certlflcete of officllr authorized by law to take acknowledgments Is nol essenllal 10 the validity of Notice of Federal Tax lien <br />Rev, Ru!. 71-466, 1971 - 2 C,8, 409) <br /> <br />Form 668(Y) (Rev, 12-85) <br /> <br />Part 1 - Kept By Recording Office <br /> <br />L <br /> <br />L <br /> <br />-l <br /> <br />" <br /> <br />..J <br /> <br />,j <br /> <br />r-- <br /> <br />..J <br /> <br />~... <br />h- <br />