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<br />05/16/2007 WED 15:08 <br /> <br />()b <br /> <br />Form 668 (Y)(C) <br />(Rev. February 2004) <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />12414 <br /> <br />1dJ002/002 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Uen <br /> <br />Area: Serial Number <br />WAGE & INVESTMENT AREA fio2 <br />Lien Unit Phone: (BOO) B29-7650 362703907 <br /> <br />As provided by section 6321, 6322, and 6]2] of the Internal Revenue <br />Code, we are giving a notice that taxes (induding interest and penalties) <br />have been assessed against the fonowlng-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 all. property and rights to <br />property belohJing to this taxpayer for the amount of these taxes, and <br />additional penaities, interest, and costs that may accrue. <br /> <br />Name of Taxpayer DAVID E SCHREIBER <br /> <br />Residence <br /> <br />230 NORTH LN <br />GRAND ISLAND, NE 68803-7011 <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 />(b) <br />12/31/2003 <br /> <br />Identifying Number <br />(c <br />XXX-XX-2395 <br /> <br />Date of <br />Assessment <br />d <br />03/20/2006 <br /> <br />last D~ for <br />Retiling <br />e <br />04/19/2016 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />the <br /> <br />03rd day of May <br /> <br />2007 <br /> <br />Signature <br /> <br /> <br />Title <br />ACS <br />(800) 829-7650 <br /> <br />for DEBRA K. HURST <br /> <br />For Optional Use by Recording Office <br /> <br />NE S..e: ..f Slot.. John II Gol.. . UCC FTI.. <br /> <br /> <br />9907509829-1 Pss: 1 <br />SCHREIBER DAVID E <br />Fil.d: 86/16/2007 11:40 AM <br /> <br />200703994 <br /> <br />Unpaid Balance <br />of Assessment <br /> <br />11972.66 <br /> <br />Total $ <br /> <br />11972.66 <br /> <br />12-00-0000 <br /> <br />Pan 1 . Kept By Recording Office <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not esse'ntial to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466,1971 .2 C.B. 409) <br /> <br />Form 668(Y)(c) (Rev. 2.20041 <br />CAT. NO 60026X <br /> <br />.~ <br />