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<br />02/12/2009 THU 10:45 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1dJ002/002 <br /> <br />o~ <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 />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 513566209 <br /> <br />As provided by section 6321, 6322, and 6323 of the Intemal Revenue <br />Code, we are giving a notice that taxes (including interest and penalties) <br />have been assessed against the followlng"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 MICHAEL CZAPLEWSKI & CHERYL COOK <br /> <br />For Optional Use by Recording Office <br /> <br /> <br />PTL <br /> <br />Residence <br /> <br />1315 SANDRA RD <br />GRAND ISLAND, NE 68801-9740 <br /> <br />200901013 <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 /> Tax Period Date of Last DarT. for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refi IUI of Assessment <br />a (b) (c) (d (e) (0 <br />1040 -12/31/1999 XXX-XX-3264 OS/22/2000 06/21/2010 <br />1040 12/31/1999 XXX-XX-3264 05/06/2002 06/05/2012 5709.33 <br />1040 12/31/2000 XXX-XX-3264 12/24/2001 01/23/2012 2706.48 <br />1040 12/31/2001 XXX-XX-3264 03/31/2008 04/30/2018 5233.24 <br /> <br />Place of Filing <br /> <br />Register of needs <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br /> <br />Total $ <br /> <br />13649.06 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />02nd day of February <br /> <br />2009 <br /> <br />the <br /> <br />for WILMA <br /> <br /> <br />Title <br />REVENUE 'OFFICER <br />(308) 384-4850 <br /> <br />24-10-1739 <br /> <br />Signature <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the vlJlidity of Notice of Federal Tax lien ~ <br />Rev. Ru!' 71-466, 1971 - 2 C.B. 409) . Form 668(Y)(c) (Rev. 2-20041\ \: <br />Part t - Kept By Recordtng Office CAT. NO 60025~ \,; <br /> <br />" <br />