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<br />10/21/2008 TUE 14:56 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121004/004 <br /> <br />rPo ' <br /> <br />\J Form 668 (Y)(<:) <br />(Rev. February 20041 <br /> <br />8801 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien 200808 918 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 480771208 <br /> <br />As provided by section 6]21, 6322, and 6323 of the Internal Revenue <br />Code, we are gtvlng 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 DENNETA M KLINGINSMITH <br /> <br />For Optional Use by Recording Office <br /> <br />ME See of' St.t... JClhn A Gals.. UC:C I=TL <br /> <br /> <br />9908573920-5 Pas: 1 <br />KLINGINSMITH DENNETA M <br />Fii.d, 10/21/2008 12:15 PM <br /> <br />Residence <br /> <br />1621 HAGGE AVE <br />GRAND ISLAND, NE 68801-7446 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (el, 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 />12/31/2004 <br /> <br />Identifying Number <br />(c) <br />XXX-XX-0722 <br /> <br />Date of <br />Assessment <br />(d) <br />03/05/2007 <br /> <br />Last Day for <br />Refiting <br />(e <br />04/04/2017 <br /> <br />Unpaid Balance <br />of Assessment <br />f) <br />3622,27 <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 />3622.27 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />the <br /> <br />08th day of October <br /> <br />2008 <br /> <br />Signature <br /> <br />Title <br />REVENUE OFFICER <br />for TOM MURPHY (402) 361-0245 <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 66800(e) IRev. 2.2004) k/ <br />Part 1 . Kept By Recordin. OffIee CAT. NO 60025X <br /> <br /> <br />24-10-2340 <br />