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<br />02/05/2009 THU 14:35 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1dJ002/003 <br /> <br />ff <br />/ 'J <br />'\ Form 668 (Y)(C) <br />(Rev. February 20041 <br /> <br />8801 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien 200900811 <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 511208109 <br /> <br />As provided by section 632t, 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 liabifity, but it remains unpaid. Therefore, <br />there is a Uen 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 cosu that may accrue. <br /> <br />Name of Taxpayer COFFEE N CREAM INC , a Corporat~on <br /> <br />For Optional Use by Recording Office <br /> <br />11111' III Inri 0 'I <br /> <br />9909586042-0 INC n CORPORR <br />COFFEE N CREAM , .. <br />'Filed: 02/05/2009 11:15 RM <br /> <br />r <br /> <br />Residence <br /> <br />1247 N BURLINGTON AVE <br />HASTINGS, NE 68901-3011 <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 />i' <br />r <br /> <br />; <br />, . <br /> <br />Kind of Tax <br />(a) <br />941 <br /> <br />Tax Period <br />Ending <br />(b) <br />06/30/2008 <br /> <br />Identifying Number <br />- (c) <br />71-0937456 <br /> <br />Date of <br />Assessment <br />(d) <br />12/22/2008 <br /> <br />Last Day for <br />Refiling <br />(e) <br />01/21/2019 <br /> <br />,Unpaid Balance <br />of Assessment <br />(0 <br />9324.82 <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 />9324.82 <br /> <br />This notice was prepared and signed at <br /> <br />. CHICAGO, IL <br /> <br />/ on this, <br /> <br />the <br /> <br />26th day of January <br /> <br />2009 <br /> <br />Signature <br /> <br />Title <br />REVENUE OFFICER <br />for ERIC MARTIN (402) 437-5462 <br /> <br />. CNOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien V <br />Rev. Rul. 71-466, 1971 - 2 C.B. 4091 . . Form 66BroCe) (Rev. 2-2004 <br />Part 1 . Keat Iv ~rdln.. Offiu _ . _ .._ ~ _ _ _ _.. <br /> <br /> <br />24-10-1721 <br />