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<br />10/17/2008 FRI 14:36 <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br />200808832 <br /> <br />121003/003 <br /> <br />D~ <br /> <br />8801 <br /> <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br /> <br />Department of the Treasury - Internal Revenue Service <br /> <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 480205708 <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 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 p.enalties, interest, and costs that mayacerue. <br /> <br />Name of Taxpayer LARRY J HOLDER <br /> <br />~'Il"liijill <br /> <br />Fjje~~ ~:'1t J Pes, 1 <br />12008 11:42 AM <br /> <br />Residence <br /> <br />515 W 16TH ST <br />GRAND ISLAND, NE 68801-3511 <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 /> Tax Period Date of Last Dal. for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Reft nr of Assessment <br />(a) (b) (e) Cd) Ce) CO <br />1040 12/31/2003 XXX-XX-5695 05/31/2004 06/30/2014 106.56 <br />1040 12/31/2005 XXX-XX-5695 11/06/2006 12/06/2016 7657.93 <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 />7764.49 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />the <br /> <br />07th day of October <br /> <br />2008 <br /> <br />Signature <br /> <br />Title <br />ACS <br />for MICHAEL W. COX (800) 829-3903 <br /> <br />(NOTE: Certificate of officer authorized by law to take acknOWledgment is not essential to the validity of Notice of Federal Tax lien V. <br />Rev. Rul. 71-466,1971 - 2 C.B. 4091 . Form 668(Y)(c) (Rev. 2-2004) <br />Part I - Kept By Recordln, Office CAT. NO 60025X <br /> <br /> <br />24-00-0008 <br />