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<br />02/05/2009 THU 14:35 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121003/003 <br /> <br />,.~\) <br />\J <br /> <br />8801 <br /> <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />200900810 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 511667609 <br /> <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving 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 MICHELLE RINCON <br /> <br />For Optional Use by Recording Office <br /> <br />\II(I'II"I~' <br /> <br /> <br />9909586043-2 <br />R~NCOdN 1'l02IC/~~~09 11:16 Rl'I <br />FLle : <br /> <br />Residence <br /> <br />421 E 5TH ~T APT 1 <br />GRAND ISLAND, NE 68801-4669 <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 IRe 6325(a). <br /> <br />~~ <br />j <br /> <br />Kind of Tax <br />(a) <br />1040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2005 <br /> <br />i. <br /> <br />Identifying.Number <br />(c) <br />XXX-XX-9073 <br /> <br />Date of <br />Assessment <br />(d) <br />12/10/2007 <br /> <br />Last Day for <br />Refiting. <br />(e) <br />01/09/2018 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />14782.82 <br /> <br />:' <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 />14782.82 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL. <br /> <br />I on this, <br /> <br />j. <br /> <br />the <br /> <br />27th day of January <br /> <br />2009 <br /> <br />Signature <br /> <br />Title <br />ACS <br />for MICHAEL W. cox (800) 829-3903 <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. Rul. 71-466,1971 - 2 C.B. 409) <br /> <br /> <br />24-00-0008 <br /> <br />/ <br /> <br />Part 1 .. lC.,t Rv RiIW'N'dln... nm,.,. <br /> <br />Form 668(Y)(c) (Rev. 2-2004) <br />