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<br />05/06/2008 TUE 14:22 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />l4J005/007 <br /> <br />Q~ <br /> <br />1924 <br /> <br />Department of the Treasury - Internal Revenue Service <br />. Notice of Federal Tax Lien <br /> <br />200803904 <br /> <br />Form 668 (Y)(C) <br />(Rev. February 20041 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 440821008 <br /> <br />As. provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that taxes (induding interest and penalties) <br />have been assessed against the following-named taxpayer. We have made <br />a demand for payment of this liabi6ty, 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 acerue. <br /> <br />Name of Taxpayer LAMONT L GILLHAM <br /> <br />For Optional Use by Recording Office <br /> <br />Imllll rUl' I' <br /> <br /> <br />9908558732-7 p . <br />GILLHAM LAMONT L gs. 1 <br />Filed: 06/06/2008 10,29 AM <br /> <br />Residence <br /> <br />208 W 12TH ST <br />WOOD RIVER, NE 68883-9164 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the tien 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 />(c) <br />XXX-XX-4116 <br /> <br />Date of <br />Assessment <br />(d) <br />10/30/2006 <br /> <br />Last Day for <br />Refiling <br />(el <br />11/29/2016 <br /> <br />Un,ald Balance <br />of Assessment <br />(0 <br />10512.79 <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 />10512.79 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />the <br /> <br />24th day of April <br /> <br />2008 <br /> <br />Signature <br /> <br /> <br />Title <br />ACS <br />(800) 829-3903 <br /> <br />24-00-000'8 <br /> <br />for REGINA OWENS <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. Ru!. 71466,1971 - 2C.S. 4091 Form "8(Y)(e) (Rev. 2-20041 V <br />Part. . Kept By ReCordIn, Office CAT. NO 60025X <br />