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<br />06/08/2007 FRI 15:37 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1aJ002/002 <br /> <br />G; <br /> <br />o Form 668 (Y)(C) <br />(Rev. February 2004) <br /> <br />1671 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />200704788 <br /> <br />Area: Serial Number <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone: (800) ,829-7650 367045907 <br /> <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, ,we are siving 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 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 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 HERBERT L MOSTEK <br /> <br />For Optional Use bv Recordin Office <br /> <br />NE See: of st..... .Ji:lIhn A Gala - Ute "L <br /> <br /> <br />9907512835-9 Pss: 1 <br />MOSTEK HERBERT L <br />Filed: 06/0812007 12:28 P" <br /> <br />'Residence <br /> <br />1510 E CHARLEY PARK RD <br />GRAND ISLAND, NE 68801 <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 />~m the day following such date, operate as a certificate of release as defined <br />-,in IRC 6325(a). <br /> <br />- Kind of Tax <br />(a) <br />1040 <br /> <br />Tax' Period <br />Ending <br />(b) <br />12/31/2004 <br /> <br />Identifying Number <br />(c <br />XXX-XX-9302 <br /> <br />Date of <br />Assessment <br />(d) <br />03/20/2006 <br /> <br />last Day for . <br />Refiling <br />(e) <br />04/19/2016 <br /> <br />Unpaid Balance <br />of Assessment <br />f) <br />7827.19 <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 />7827.19 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />the <br /> <br />24th day of May <br /> <br />2007 <br /> <br />Signature <br /> <br /> <br />Title <br />ACS <br />(800) 829-7650 <br /> <br />12-00-0000 <br /> <br />for DEBRA K. HURST <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rut. 71-466,1971 - 2 C.B. 409) . <br /> <br />Part 1 ~ Kept By RecordinB Office <br /> <br />Form 668(Y)(c) (Rev. 2-2004) <br />CAT. NO 60025X <br /> <br />'f- <br />