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<br />o Form 668 (Y)(c). <br />(Rev. February 20041 <br /> <br />1924 <br /> <br />04/08/2008 TUE 15:52 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121002/002 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien 2 0 0 8 0 2 9 6 0 <br /> <br />Area: Serial Number For Optional Use by Recording Office <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 433842508 <br /> <br />As provided by section 6321, 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 E:RIKA FLORES <br /> <br />Residence <br /> <br />2013 COTTAGE: ST <br />GRAND ISLAND, NE: 68803~2107 <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 />12/31/2005 <br /> <br />Identifying Number <br />(e) <br />XXX-XX-4495 <br /> <br />Date of <br />Assessment <br />(d) <br />08/14/2006 <br /> <br />Last Day for <br />Refiling <br />e <br />09/13/2016 <br /> <br />Unpaid Balance <br />of Assessment <br />o <br />25672.45 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />the <br /> <br />28th day of March <br /> <br />2008 <br /> <br />Signature <br /> <br /> <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br /> <br />for KAY PONTE: <br /> <br /> <br />Total $ <br /> <br />25672.45 <br /> <br />24-10-2339 <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. 409) Form 668(Y)(c) (Rev. 2.2004) .. <br />Part t - Kept By Recordln, Office CAT. NO 60025X Y <br />