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<br />11/19/2007 HON 15:31 <br /> <br />Dca <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />~004/004 <br /> <br />4653 <br /> <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br /> <br />Department of the Treasury - Internal Revenue Service <br /> <br />Notice of Federal Tax Uen <br /> <br />200709857 <br /> <br />Area: - Serial Number <br />WAGE & INVESTMENT AREA #2 <br />lien Unit Phone: (800) 829-7650 403073407 <br /> <br />- ~ provided by section 6121, 6322, and 6121 of the Internal Revenue <br />Code, we are giving a notice that taxes (includin,lnterest and penalties) <br />have been assessed against the followin.....med taxpayer. We have made <br />a demand for payment of this IlabiUey, but It remains unpaid. Therefore, <br />there Is a Den in favor of the United States on aU property and rish" -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 RUFINO S GARCIA <br /> <br />For Optional Use by Recording Office <br /> <br />III ,.., 01 sut. John A G..lo . UCC I'TL <br /> <br /> <br />9907534224-0 pgs: 1 <br />GARCIA RUFINO S <br />Fll~d, 11/19/2007 09:32 RM <br /> <br />Residence - <br /> <br />716 SPINE ST <br />GRAND ISLAND, NE 68801-7941 <br /> <br />IMPORTANT RELEASE INfORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (aI, 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 />-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-0176 <br />XXX-XX-0176 <br /> <br />Date of <br />Assessment <br />(d) <br />12/18/2006 <br />12/18/2006 <br /> <br />Last Day for <br />Refillng <br />(e) <br />01/17/2017 <br />01/17/2017 <br /> <br />Un~aid Balance <br />of Assessment <br /> <br />4390.51 <br />6271. 33 <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 />10661.84 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />tne <br /> <br />08th day of November <br /> <br />2007 <br /> <br />Signature <br /> <br /> <br />Title <br />ACS <br />(800) 829-7650 <br /> <br />- 12-00-0000 <br /> <br />for DEBRA K. HURST <br /> <br />(NOTE: Certificate of officer authorized bV 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) Form 668(Y)(c) (Rev. 2.2004) <br />Part. . Kept By Recordla, OffIce CAT. NO 60025X ~ <br />