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<br />12/23/2008 TUE 14:26 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1;ilI005/007 <br /> <br />DQJ <br /> <br />8801 <br /> <br />Form 668 (Y)(C) <br />(Rev. Februarv 2004) <br /> <br />Department .of the Treasury - Internal Re~enue Service 2 0 0 8 1 0 3 5 9 <br />Notice of Federal Tax Lien <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />lien Unit Phone, (800) 913-6050 502084308 <br /> <br />As provided by section 6321, 6322, and 6323 of che Incemal Revenue <br />Code, we are giving a nocice chac taxes (Including Interest and penalties) <br />have been assessed against the following-named taxpayer. We have made <br />a demand for payment of chis liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the Unlced States on ail property and rights to <br />property belonging to this taxpayer for the amount of these taxes, a,nd <br />additional penalties, interest, and costs that may accrue. <br /> <br />Name of Taxpayer JOSE L LOPEZ <br /> <br />For Optional Use by Recording Office <br /> <br />1111' rllll" Ir ~r ~ 'I <br /> <br /> <br />9908580273-1 Pas: 1 <br />LOPEZ JOSE L <br />Filed: 12/23/2008 12,58 PM <br /> <br />Residence <br /> <br />928 S LOCUST ST <br />GRAND ISLAND, NE 68801-6768 <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 />Kind of Tax <br />(a) <br />1040 <br />1040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2002 <br />12/31/2004 <br /> <br />Identifying Number <br />(c) <br />XXX-XX-8211 <br />XXX-XX-8211, <br /> <br />Date of <br />Assessment <br />(d) <br />02/25/2008 <br />03/03/2008 <br /> <br />Last Day for <br />RelUing <br />(e) <br />03/27/2018 <br />04/02/2018 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />38631.83 <br />31170.12 <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 />69801.95 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />. on this. <br /> <br />the. <br /> <br />16th day of December <br /> <br />,2008 <br /> <br />Signature <br /> <br />Title <br />REVENUE OFFICER <br />for WILMA K PONTE (308) 384-4850 <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien \ J <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-20041 V <br />Part ( . KeItt BY Recordinr Office ("AT II.1n flnn7f;X <br /> <br /> <br />24-10-1739 <br />