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<br />04/29/2008 TUE 15:32 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121003/003 <br /> <br />'~ <br /> <br />1924 <br /> <br />Department of the Treasury ~ Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />200803630 <br /> <br />Fom 668 (Y)(C) <br />(Rev. February 20041 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 438574808 <br /> <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are pin. 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 aU property and rights to <br />property belongins to this taxpayer for the amount of these taxes, and <br />additional penaldes, Interest, and costs that mayaccrue. <br /> <br />Name of Taxpayer MARTIN ACOSTA <br /> <br />For Optional Use by Recording Office <br /> <br />\1111111111 <br /> <br /> <br />9908557181-9 pgs. 1 <br />ACOSTA 1'IA04RJT29IN/2008 12.31 PM <br />Filed, . <br /> <br />Residence <br /> <br />422 W 10TH ST <br />GRAND ISLAND, NE 68801-4044 <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 /> Tax Period Date of Last Da{g for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment ReO mg of Assessment <br />(a) (b) (c) (d) ee) CO <br />1040 12/31/2002 XXX-XX-3057 10/29/2007 11/28/2017 10715.61 <br />1040 12/31/2003 XXX-XX-3057 10/29/2007 11/28/2017 19229.09 <br />1040 12/31/2004 XXX-JO{-3057 03/26/2007 04/25/2017 9758.44 <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 />39703.14 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, - --, . <br /> <br />the <br /> <br />16th day of April <br /> <br />2008 <br /> <br />Signature <br /> <br /> <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br /> <br />24-10-2339 <br /> <br />for KAY PONTE <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 66800(1;) (Rev. 2-2004) <br />Part 1 . Ktpt By Recordl... Office r.AT. NO 60026X <br /> <br />v <br />