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<br />07/09/2008 WED 15:32 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall
<br />
<br />~003/004
<br />
<br />~
<br />
<br />Form 668 (Y)(C)
<br />(Rev. February 2004)
<br />
<br />4653
<br />
<br />Department of the Treasury - Internal Revenue Service
<br />
<br />Notice of Federal Tax Lien
<br />
<br />200805939
<br />
<br />Area; Serial Number For 0 tional Use by Recording Office
<br />SMALL BUSINESS/SELF EMPLOYED AREA #4
<br />Lien Unit Phone: (800) 913-6050 453889108
<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 RICKY L & AMY J HADENFELDT
<br />
<br />
<br />Residence
<br />
<br />PO BOX 1691
<br />GRAND ISLAND, NE 68802-1691
<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 />12/31/2003
<br />
<br />Identifying Number
<br />(c)
<br />XXX-XX-1544
<br />
<br />Date of
<br />Assessment
<br />d
<br />05/17/2004
<br />
<br />Last D~ for
<br />Refiting
<br />(e)
<br />06/16/2014
<br />
<br />Unpaid Balance
<br />of Assessment
<br />(f)
<br />3755.24
<br />
<br />-------..--"--.-------- ...
<br />.........-..._,..".."".,.......,_..."~...",,....,..,~~..,...._,_.~~- ~-,...,......._.......,.....,..- .....,.,.,.,...,", ,. ,...,,~..,.
<br />
<br />._ ..______._ _.n
<br />.0.. ".".,~,.,'..._ ..".....,...._,,,.. ..., ,._~.._.
<br />
<br />..... ... ::. :".: :~.-.:::..;: "'::'."_~,~, ':.'.: .._n'. ...",., ,~;.::.~.'.: ,,~:;~_~:::......':':':'~~.-::_~:-:..;:::.7..: ~~~~,'" :-:=~~..:~=':":'::'""~_7..:.;:.::.:..~_.:.~.~ 0..
<br /> '::-:"""."-';='.-,.,
<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 />3755.24
<br />
<br />This notice was prepared and signed at
<br />
<br />CHICAGO, IL
<br />
<br />, on this,
<br />
<br />the
<br />
<br />27th day of June
<br />
<br />2008
<br />
<br />Signature
<br />
<br />Title
<br />REVENUE OFFICER
<br />for KAY PONTE (30B) 384-4850
<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. Aul. 71-466, 1971 - 2 C.B. 4091 Form 668(Y)(c) (Rev. 2~20041
<br />Part t . Kept By Recording Office . CAT. NO 60025X
<br />
<br />
<br />24-10-2339
<br />
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