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<br />06/13/2007 WED 15:30 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />o~ <br /> <br />Form 668 (Y)( c) <br />lRev. February 2004) <br /> <br />12414 <br /> <br />~002/002 <br /> <br />Notice of Federal Tax Lien <br /> <br />Department of the Treasury - Internal Revenue Service <br /> <br />200704929 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED-AREA #4 <br />Lien Unit Phone: (800) 913-6050 368198207 <br /> <br />A5 provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are sMng a' notice that taxes (including interest and penalties) <br />have been assessed against the followingOonamed taxpayer. We have made <br />-.,:a-deinilid-for--payment,ofthis-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 JAMES A MATSON <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 date, operate as a certificate of release as defined <br />in IRe 6325(a). <br /> <br />Kind of Tax <br />(a) <br />941 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2006 <br /> <br />- Identifying Number <br />(e) <br />81-0640267 <br /> <br />Date of <br />Assessment <br />(d) . <br />03/26/2007 <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 />31st day of May <br /> <br />2007 <br /> <br /> <br />For Optional Use by Recording Office <br /> <br />....o~IIIIII',I,=.~ <br /> <br />9907513382-9 Pss' 1 <br />MRTSON JAAEs R . <br />FlIed: 06/13/2007 11:52 AM <br /> <br />Last Day for <br />Retiling <br />(e) <br />04/25/2017 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />3078.59 <br /> <br />Total $ <br /> <br />3078.59 <br /> <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br /> <br />24-10-2337 <br /> <br />Signature <br />for MICHAEL W PONTE <br /> <br />Part . - Kept By Recording Office <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. Rul. 71-466,1971.2 C.B. 409) <br /> <br />y <br /> <br />Form 668(Y)(c) (Rev. 2-2004) <br />CAT. NO 60025X <br />