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<br />03/13/2007 14:52 FAX 14024714429 <br /> <br />NEBRASKA Dee <br /> <br />~ 002/005 <br /> <br />~ <br /> <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br /> <br />12414 <br /> <br />Department of the Treasury - Internal RevenUe Service <br />Notice of Federal Tax Lien <br /> <br />20070 19'09 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 348963507 <br /> <br />A5 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 followina-named taxpayer. We have made <br />I 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 and' rights to <br />property belonKin. to this taxpayer for the amount of these taxes, and <br />additional penakies, interest, and costs that may accrue. <br /> <br />Name of Taxpayer JAMES A MATSON <br /> <br />For Optional Use by Recording Office <br /> <br />MRTSON J0eME'1S31~7 09.43 AM <br />Fil~: '" . <br /> <br />Residence <br /> <br />3090 W 2ND ST <br />GRAND ISLAND,.NE 68803-5264 <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 qate, operate as a certificate of release as defined <br />in IRC 6325(a). <br /> <br />Kind of.Tax <br />(a) <br />941 <br /> <br />Tax Period <br />Endin,_ <br />(b) <br />09/30/2006 <br /> <br />Identifying Number <br />(c) <br />81-0640267 <br /> <br />Date of <br />, Assessment <br />(d) <br />12/25/2006 <br /> <br />Last D~ for <br />Retilinl - <br />(e) <br />01/24/2017 <br /> <br />Unpaid Balance <br />of Assessment <br />(I) <br />5675.16 <br /> <br />Place of Filing <br /> <br />~egister of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br /> <br />Total $ <br /> <br />5675.16 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAuL, MN <br /> <br />, on this. <br /> <br />the <br /> <br />05 th day of March <br /> <br />2007 <br /> <br />Signature <br /> <br />Title <br />REVENUE OFFICER <br />for MICHAEL W PONTE (308) 384-4850 <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien cJ <br />Rev. RuL 71-466, 1971 - 2 C.B. 409)'1 '. Form 668(Y)(c) (Rev. 2-2004) <br />II Part 1 . Kept By Recording Office . CAT. N~ 60025X <br /> <br /> <br />24-10-2337 <br />