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<br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />~003/005 <br /> <br />1924 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />200709521 <br /> <br />Area: Serial Number <br />SMALL , BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 399954907 <br /> <br />,"provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are givina 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 kremains unpaid. Therefore, <br />there is a lien in favor of the United States on all property and richts to <br />property belongina to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br /> <br />Name of Taxpayer DAVE JANOVEC <br /> <br />For Optional Use by Recording Office <br /> <br />\11111'11'1 <br /> <br /> <br /> <br />9907532619-5 <br />JANOVEd c,qA/~/2007 10:11 IlI'I <br />File : .. <br /> <br />Residence <br /> <br />644 S LOCUST ST. <br />GRAND ISLAND, NE 68801-6700 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below. <br />unless notice of the lien is refiled by tt!e date given in column (e), this notice shall, <br />on the day following such d'ate, operate as a certificate of release as defined <br />in IRC 6325(a). <br /> <br />Kind of Tax <br />(a) <br />940 <br />940 <br /> <br />Tax Period <br />Endina <br />(b) <br />12/31/2004 <br />12/31/2006 <br /> <br />Identifying Number <br />(e) <br />91-1762829 <br />91-1762829 <br /> <br />Date of <br />AJsessment <br />(d) <br />09/03/2007 <br />09/10/2007 <br /> <br />Last Day for <br />Refillng <br />(e) <br />10/03/2017 <br />10/10/2017 <br /> <br />Unpaid Balance <br />, of Assessment <br />(I) <br />1246.69 <br />~186.14 <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 />2432~83 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this. <br /> <br />24 th day of October <br /> <br />2007 <br /> <br />the <br /> <br />for PAT KE~LOGG <br /> <br /> <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br /> <br />24-10-2341 <br /> <br />Signature <br /> <br />(NOTE: Cenificate 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. 409) . Form 668(Y)(e) (Rev. 2-2004) <br />Part 1 . Kept By Recordln, Office CAT. NO 60025X ' <br />