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<br />07/21/2008 MON 15:11 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1210041004 <br /> <br />~ <br /> <br />\J Form 668 (Y)(C) <br />(Rev. February 2004) <br /> <br />4653 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Uen <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 456306008 <br /> <br />As provided by section 632., 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 Uability, 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 FOURTH STREET CAFE INC <br /> <br />For <br /> <br /> <br />HI. <br /> <br /> <br />9908566321-6 PSI$: 1 <br />FOURTH STREET CAFE INC <br />Filed: 0712112008 11,30 RM <br /> <br />200806237 <br /> <br />Residence <br /> <br />2848 S LOCUST ST <br />GRAND ISLAND, NE 68801-8862 <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 />941 <br />CIVP <br /> <br />Tax Period <br />Ending <br />b) <br />12/31/2007 <br />12/31/2003 <br /> <br />Identifying Number <br />(c) <br />47-0784697 <br />47-0784697 <br /> <br />Date of <br />Assessment <br />(d) <br />03/31/2008 <br />10/09/2006 <br /> <br />Last Day for <br />Refillng <br />(e) <br />04/30/2018 <br />11/08/2016 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />325.58 <br />7516.20 <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 />7841.78 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, XL <br /> <br />, on this, <br /> <br />10th day of July <br /> <br />2008 <br /> <br />the <br /> <br />Signature <br /> <br /> <br />Title <br />ACS <br />(800) 829-3903 <br /> <br />24-00-0008 <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!' 71-466, 1971 .2 C.B. 4091 Form 668(Y)(c) (Rev. 2-2004) <br />Part 1 . Kept By Recording Office CAT. NO 60025X <br /> <br />\0 <br />