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<br />08/27/2007 MON 16:51 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1lI005/006 <br /> <br />~' <br /> <br />\) Form 668 (Y)(c) <br />(Rev; February 20041 <br /> <br />1924 <br /> <br />Department of the Treasury. Internal Revenue Service <br /> <br />Notice of Federal Tax Lien <br /> <br />200707364 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 384236207 <br /> <br />As provided by section 632t, 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 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 TIMOTHY R CHAGNON <br /> <br />For Optional Use by Recording Office <br /> <br />111[1'llllll~ r <br /> <br />9907523238-6 Pss' 1 <br />CHAGNON TIMOTHY R . <br />Filed: 08/27/2007 02,42 PM <br /> <br />Residence. <br /> <br />1505 E 7TH ST <br />GRAND ISLAND, NE 68801-2923 <br /> <br />IMPORTANT I,tELEASE 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 IRC 6325(a). <br /> <br />Kind of Tax <br />(a) <br />1040 <br /> <br />Tax Period <br />Ending <br />Cb) <br />12/31/2004 <br /> <br />. Identifying Number <br />(c) <br />XXX-'XX-5314 <br /> <br />Date of <br />Assessment <br />Cd) <br />10/23/2006 <br /> <br />Last Day for <br />Refiling <br />(e) <br />11/22/2016 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />12571.36 <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 />12571. 36 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />I on this, <br /> <br />. . <br /> <br />the <br /> <br />13th day of August <br /> <br />2007. <br /> <br />for KAY PONTE <br /> <br /> <br />Title <br />REVENUE'OFFICER <br />(308) 384-4850 <br /> <br />24,..10-2339 <br /> <br />Signature <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. Ru!' 71-466. 1971 - 2 C.B. 4091 Form 668(Y)(c) (Rev, 2-2004) f'\~ <br />Part. - Kept By Recording Office CAT. NO 60025X "J;- . <br />