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<br />Form
<br />
<br />668(C)
<br />
<br />
<br />,H-~7- --- -- --,
<br />,~ Department of the Treasury -Internal Revenue Service
<br />
<br />I
<br />
<br />(Rev. Feb., 1983) i
<br />
<br />__._____.__________._.L, _.
<br />Distriot , _ _ _ '
<br />Oma h i(' 'J ;(i'r;~ .
<br />
<br />NoticrnFedetdl Tax lien Under Internal Revenue laws
<br />~,-".-._- .".'" " ~,.
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<br />
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<br />~S.p'rOVlcted by ~~~!!.2~,!:.~~~ an~ 6:2!i,theln!e~~~,~~\ve~~.: ~de,
<br />"o...ce, , n~ I.~~,.,\\""n",_"nzlt In.~",,_....,-.n~ t'e'I~II.''''OI hpy~ usen
<br />asse st'the TOlldVling"nla.... tlillJiay'et, Demand for payment of
<br />this flab has been made, but it remains unpaid, Therefore, there is a lien
<br />In favcirof the United !:\tat@ll'pn all proJ'erty and rights to property belonging
<br />to thi$ taxpayer for-.tt$-am()(lflt o.f tl1e$4! taxelt; aM additional penalties,
<br />Interi!8t, and costs that may acerue,
<br />
<br />84 - 003663
<br />
<br />NameofTaxpayer Haney, Tom
<br />
<br />Residence
<br />
<br />1030 East Phoenix
<br />Grgnd lsJand, Nebraska 68801
<br />
<br />IMPORTANT RELEASE INFORMATION: With ,espect to each assessment Iisted.below. unless
<br />notice--of Hem' is,,-refHed by the, date given in colum~ (e), this notice shall. on the day .following
<br />",' such date.. operate ~ a certificate of release as defined in IRC 6325 (a).
<br />
<br />KlndofTlix
<br />fa)
<br />
<br />TaX~rtcid
<br />. Ended
<br />I (bl -
<br />; U9-30-83
<br />!12-31-83
<br />
<br />Date 01
<br />Identifying Number i Assessmel'it
<br />(e).~ . fd)
<br />4 7=bITT3T 1 ! ir6-"- 1 - 8 4
<br />103-26-84
<br />
<br />
<br />Unpaid Balance
<br />of Assessment
<br />Iq
<br />i$ 1,743;52
<br />!$ 369.40
<br />!
<br />
<br />
<br />"'"
<br />
<br />941
<br />941
<br />
<br />~
<br />
<br />
<br />~
<br />
<br />Omaha Nebraska
<br />
<br />
<br />! I"
<br />
<br />~~___L_~___L__ ..L~ i
<br />Rlace,ot-F:i1in9Registe.r" of Dee.ds I 2-,;1-1.Z.~9-a"
<br />Ha 11 County Grand I s land, Nebraska 68S010tel I $
<br />
<br />______.--,----,,'~~~~ ..............I,>....c
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<br />This notice was prepared and signed at _
<br />
<br />21st June 84
<br />Ihe___dayot___~_____.19__..___
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<br />---------------_._--~=;--------_.
<br />Signature~;;, '"~/ 4',L-n .h'
<br />d~~e' ~------
<br />
<br />Part 1 .- To be Kept bv Rec'Jrding Ofiic,"
<br />
<br />Form 668(CI(flev. 2-83)
<br />
<br />J
<br />
<br />,_ ._~_e v~J!."l_QiLice r ________
<br />
<br />(NOTE: Ce,rifk;Bte of officer au(tlorizea by law to tai<.e acknowWdgments is not essenrial to the validity of Notice ofFfJd8raf Tax Lien
<br />Rev RIl! 71-466, 1971.2. C.B. 409)
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