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<br />10/17/2008 FRI 14:36 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />200808831 <br /> <br />121002/003 <br /> <br />1)'b <br />Form 668 (Y)(c) <br /> <br />8801 <br /> <br />Department of the Treasury - Internal Revenue Service <br /> <br />Notice of Federal Tax Lien <br /> <br /> <br />E~~~~~;~~1~~~~~~:m~~=L= ~lf"'I"1 <br /> <br /> <br />have been assessed a,alnst the followinr-named taxpayer. We have made F' ilAMY JOHN Pli/ll' 1 <br />a demand for payment of this liability, but it remains unpaid. Therefore, ~ ed, 10117/2008 11:42 AM . <br />there Is a lien In favor of the United States on all property and rights to <br />property belongln, to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br /> <br />Name of Taxpayer JOHN & BONNIE BELLAMY <br /> <br />(Rev. February 2004) <br /> <br />Residence <br /> <br />15283 W NEBRASKA HWY 2 <br />CAIRO, NE 68824-9618 <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 IRe 6325(a). <br /> <br />Kind of Tax <br />(a) <br />1040 <br /> <br />Tax Period <br />Endin, <br />(b) <br />12/31/2004 <br /> <br />Identifyin, Number <br />(c) <br />XXX-XX-7512 <br /> <br />Date of <br />Assessment <br />(d) <br />11/27/2006 <br /> <br />Last Day for <br />'Retilin, <br />(e) <br />12/27/2016 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />23929.81 <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 />23929.81 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />07th day of October <br /> <br />2008 <br /> <br />the <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: Certificate of officer authorized bV 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. 4091 Form 668(Y)(c) (Rev. 2-20041 <br />Pan . - Kept By Recordln, Office CAT. NO 60025X <br />