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<br />09/09/2008 TUE 15:09 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />~004/005 <br /> <br />4653 <br /> <br />Form 668 (Y)(C) <br />(Rev. February 20041 <br /> <br />Department .of the Treasury - Internal Re:enue Service 2 0 0 8 0 7 7 7 2 <br />Notice of Federal Tax: Lien <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 467657708 <br /> <br />As provided by section 6321, 6322, and 6323 of the Ineernal 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 Scates 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 JAMES J MOSILEK <br /> <br />For Optional Use by Recording Office <br /> <br />\I(IIIII'I~\\\I <br /> <br /> <br />9908570363-0 Pes. 1 <br />~~t;~7K0~~~~2~0e 01:17 PM <br /> <br />Residence <br /> <br />4216 LARIAT CT <br />GRAND ISLAND, NE 68803-2232 <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 />1040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2002 <br />12/31/2003 <br /> <br />Identifyinl Number <br />(c) <br />XXX-XX-9135 <br />XXX-XX-9135 <br /> <br />Date of <br />Assessment <br />(d) <br />10/29/2007 <br />10/29/2007 <br /> <br />Lase Day for <br />Refiling <br />(e) <br />11/28/2017 <br />11/28/2017 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />15725.30 <br />14133.76. <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 />29859.06 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />the <br /> <br />26th day of August <br /> <br />2008 <br /> <br />for MICHAEL W. COX <br /> <br /> <br />Title <br />ACS <br />(800) 829-3903 <br /> <br />24-00-0008 <br /> <br />Signature <br /> <br />(NOTE: Cenificate 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, 1 971 - 2 C.B. 409) <br /> <br />Part 1 . Kept: By Recording OffIce <br /> <br />Form 668(Y)(c) (Rev. 2-2004) <br />CAT. NO 60025X <br /> <br />\; <br />