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<br />'- FO: 118(0 8 }~~? ;; ;~~~:-----~-o;;~m;;-~'the T';SUry ~ 1"'8",al Revenue SeMce ....
<br />
<br />I (Rev. Fob!. 1983) P ~Qe of Fedetl Tax Lien Under Internal RlMIIII$uW$
<br />Oi$t~l ' :. !, 'e T: ~'rSerialNu~, ; ---FOro;:;i;onafq."by~~
<br />a-a ~ . ,., ,. I
<br />Unal1a 4~c'i:'f '118613 OllB 4;'): .
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<br />Aa~br~~, ~_632S ()fthe Internat Revenue Code, !
<br />not. ~.'."'. ..,..,. . '.',m~.'. '. ..~...,. ttftI.. . .tD Deels '{Incl&llil..,~.' Vinte~.').' .nlf,' penaltIeS. ). have :. been.. I
<br />8B'''ledi~ the following-named taxpam. Demand forpayrmtn~1 of 1
<br />thIa',*.,. lltYlIub I.... :..... .......butl.tretnainsunp. IaN.. Thetef.. ore,.ther&..IU,..~ i
<br />in favor of t . _' :OR aIlproperty anc:tl1gMB to property belonging I
<br />to t_ tax he amount of ~ t!ix..; an!f additional penaltl.... 1
<br />I....~ .......-""~...........WlleUa~.. --C' . I,
<br />......-.........." --- -~~.--J' ...V1ilIP'II....v. 1
<br />
<br />_._-------_._-------"--._-----~,_._<.---.--~~-------.----~~
<br />Name of Taxpayer i
<br />Gustafson. James L. i
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<br />Residence ---------------------~
<br />
<br />Box 1"5
<br />Ik~ lu, Ni;; 0&&32
<br />
<br />..'.,
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<br />~ 1
<br />.
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<br />1 0'10
<br />1040
<br />104.0
<br />l.U 40
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<br />~'2-31-78
<br />fl2-:n-79
<br />~Z;";H-80
<br />~Z-31-ill
<br />
<br />Identifying Number
<br />t fe}
<br />I
<br />1508-40-1833
<br />
<br />Date.of. llm Dey'Jc!f
<br />1 . A..a:;~ ,.~n9
<br />~;~:~"::~'~t:=~i=:f-
<br />~7-26-84 p'8-25-~O
<br />r'-2~-a4 rb-25-UO
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<br />~05, 674. 'is .
<br />72,1"'3.04
<br />~;H,U5U.99
<br />~ 3,894.62
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<br />Xj~ANT'~IN..:ORMATION; With '-'10 eacI1_essmenllis1elt'_, unless
<br />;:.-n<<!~~Of:.~ ~s. rri.Ied..by- th._~- ~n in column {8}, this notice shell, cn th9 day '~ng
<br />;, 8lIChJlate,_te as,ecem~otflllease as deftnlld.jn lAC 6325{a),
<br />
<br />
<br />1 Tuhriod
<br />Ended
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<br />
<br />
<br />-:'
<br />
<br />~otFUing
<br />Register of lJeeos
<br />ila ii (:oun ty GrlilHl
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<br />_~j_.___._____.,....-_..___l_.__~_. --------.-_t__
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<br />k'1:t,76;$.41
<br />Island. Nebraska tHj8l1ptal i S
<br />
<br />-_.,----------,-------._---,--------~~-
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<br />
<br />This notice was prepared and slgne<:l at _ ,,_
<br />
<br />u..alla ,\eOl'lilika
<br />
<br />,on this.
<br />
<br />ttJ ~~ day Of:y.:_~I~~e.~.19~4_
<br />
<br />-S;gnalur~~~--~~- ... ..'-rTitle-----------~-~-------
<br />___~:....~~~iL~iU_li~i511ile1__~____. . ~.J..i:_JL~l._____ .~_9~~_<,~na~el. ,._.___"____~___,___._,,_________
<br />(NOTE: Cvrti1fCate of crfttcat ao!hoi1zed by jaw to taKe aciU"l(HNlfidgments is not essoflfJal to :tie validity of Notice of FtKiefal Tv. Den
<br />Rev RvI. 71,"66. 1971.2, G.B. 409)
<br />
<br />Part 1 - To be Kept by Recording QftiC€
<br />
<br />Form 668(C) (Rev. 2,63)
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