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<br />Forrr, UU\ ',j '- ,., (; ~') 0 t:.., tJ 0-/'
<br />I IRev. FeD, ~E==:~r-"~;;::, No~i~~_~f.s_Fe~r'I'ade, Nli1um"beTr.!!~,~ie-I!~~~! Internal Revenue laws
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<br />District PorOptionaJ U~ by Recording Office
<br />'Oman a:' 47 I 7.7 5
<br />.f t', J';;Jt: 3 05S 500
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<br />As'pr~)Vjdtd by sec~ions 6321 , 6322, and 6323o(thelnternal Revenue Code.
<br />notice,iS\'l9iven that taxes (including interest,;and penalties) have been
<br />a8S,,~ed~agalnst the foilg~lnll'~na",ed, _axPII~r.rlJlemand for payment of
<br />thlsillablllty has been made, bunt remams uriplild', :rherefore, there Isa lien
<br />in fsvcjr of the United States onall property an,c:!. tights to property belonging 84 --00866 t:
<br />to this taxpayer for the amou\1tef'.these taxe-lrl' and additional penalties, . , 'v
<br />interest, and costs that mll~l'u..; , c.
<br />
<br />NameOfTaxpayerH~'~;Y-~-'ThO~;~S' W~-&~~;~:;K.
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<br />Residence
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<br />1030 East Phoenix
<br />Gr,a,IHJIs:land, Nebraska 68801
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<br />'_ tM-~o.i:IT~A.Nr RELSA:SE;: INFORMATION: With respect to --each assessment listed below; unless
<br />"';ol1o.tice-.oklien-,is::refued-by the,date-,given in column (e), this noiice shalt, on the day following
<br />~~' such date, operate-as a certificate of-release as defined in- -IRC 6325 (a). '
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<br />. Ktnd'of Tax
<br />(a)
<br />104;0
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<br />Tax'Pericld
<br />Ended
<br />l'lbi
<br />112-31-82
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<br />1 Date of
<br />! Identifying Number i Assessment
<br />l__~__~_~~--L- _ [d) _
<br />I 505-78-9966 I04~16-84
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<br />last Day for. I
<br />Refiling ,
<br />leJ
<br />
<br />UnpBlii.BlIlance .
<br />of Assessment
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<br />105-16-90
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<br />i$ 1,213.81
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<br />O:eeds
<br />Grand Island, Nebraska
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<br />I 1,213.81
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<br />PlliceofFiling
<br />. Regl s ter of
<br />Hall County
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<br />_L------
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<br />6880lptal
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<br />This notice was prepared and signed al ,.
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<br />Omaha Nebr.aska
<br />
<br />,OIHhis,
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<br />21st June 84
<br />the_ day of ~_______.__, 19 __.______~'
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<br />SignatUre-I/~--:;"~-~----
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<br />________~~x~'!.t,e,__ _.. ,__n
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<br />..L__ ~~_~.<'..n.~f.'_Ofi_~~~._~_~_
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<br />Pert 1 -.- To be Kept by Rerording Office
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<br />Form 668(C) (Rev, 2-83) ,
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<br />(NOTE: Certificate of officer authOflzed by law 10 take acknowledgments IS nO! essential to the validity of Notice of Federal fax Lien
<br />Rev. Ru!. 71-466, 1971.2, C.B. 409)
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