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<br />10/01/2007 HON 15:23 <br /> <br />o <br /> <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121004/004 <br /> <br />4653 <br /> <br />Department of the Treasury ~ Internal Revenue Service <br />Notice of Federal Tax Lien 200708472 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 393424307 <br /> <br />As provided by section 6]21, 6]22, and 6]23 of the Internal Revenue <br />Code, we are sMng a notice diat taxes (indudlng Interest and penalties) <br />have been assessed against the followinl"'named taxpayer. We have made <br />a demand for payment of this liabiUty, 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 DENNIS D NELSON <br /> <br />For Optional Use by Recording Office <br /> <br />liE s.~ .., st.... ~.."" tI C;"I.. - ue;e; FTL <br /> <br /> <br />9907527858...,4 Pgs: 1 <br />NELSON DENNIS 0 <br />Filed: 10/01/200701:12 PM <br /> <br />Residence <br /> <br />3579 N HIWAY 281 <br />GRAND ISLAND, NE 68801 <br /> <br />IMPORTANT RELEASE INfORMATION: For each assessment listed below, <br />unless notice of the lien is refited by the date given in column (e), this notice shaU, <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 />1040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2002 <br />12/31/2003 <br /> <br />Identifying Number <br />(c) <br />XXX-XX-9068 <br />XXX-XX-9068 <br /> <br />Date of <br />Assessment <br />d) <br />07/26/2004 <br />07/26/2004 <br /> <br />Last Day for <br />Refiling <br />e <br />08/25/2014 <br />08/25/2014 <br /> <br />Unpaid Balance <br />of Assessment <br /> <br />7704.90 <br />5590.16 <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 />13295.06 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />the <br /> <br />24'th day of <br /> <br />September, 2007 <br />, <br /> <br />Signature <br /> <br />Title <br />REVENUE OFFICER <br />for MICHAEL W PONTE (308) 384-4850 ' <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. 4091 , ' 'Form 668(Y)(c:) (Rev. 2.2004IQJ <br />. Part 1 . Kept By Rec:ordlng Office CAT. NO 60Q25X " , <br />. . , <br /> <br /> <br />24-10-2337 <br />