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<br />10/01/2007 MON 15:22 <br /> <br />& <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121002/004 <br /> <br />4653 <br /> <br />Department of the Treasury - Internal Revenue Service 2 0 0 7 0 8 4 7 0 <br />Notice of Federal Tax Lien - <br /> <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br /> <br />Area: Serial Number For Optional Use by Recording Office <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone: (800) ,829..,7650 392755907 <br /> <br />- As provided by section 6321, 6322, and 63'23 of the Internal Revenue <br />Code, we are' sMng a notice that taxes (including interest and penalties) <br />have been assessed against the followin....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 ADOLFO CRUZ <br /> <br /> <br />Residence <br /> <br />310 E 4TH ST <br />GRAND ISLAND, NE 68801-4606 <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 IRC 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-3217 <br /> <br />Date of <br />Assessment <br />d <br />09/11/2006 <br /> <br />Last Day for <br />- Refiling <br />(e <br />10/11/2016 <br /> <br />Unpaid Balance <br />of Assessment <br />f <br />11270.33 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br /> <br />T otal$ <br /> <br />11270.33 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, , on this, <br /> <br />20th day of <br /> <br />SepteITlher 2007 <br />, <br /> <br />the <br /> <br />Signature <br /> <br />Title <br />ACS <br />for DEBRA K. HURST (800) 829-7650 <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. 4091 Form 668(Y)(c) (Rev. 2-2004)~ <br />. Part 1 . Kept By Recording Office CAT. NO 6Q025X \.Jf <br /> <br /> <br />12-00-0000 <br />