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<br />02/19/2009 THU 15:17 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1210021005 <br /> <br />OFonn 668 (Y)(c) <br />(Rev. February 2004) <br /> <br />8801 <br /> <br />Department of the Treasury. Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />.. <br /> <br />Area: Serial Number <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone: (800) 829-7650 514479509 <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 SHENI M SEGURA CAMPOS <br /> <br />For Optional Use by Recording Office <br /> <br />HE SIIC of s...-t-. JGlhn A Gal.. - Ute ~TL <br /> <br /> <br />9909587439-2 Pes: 1 <br />SEGURR CRMPOS SHENI M <br />Filed: 02/19/2009 10:36 RM <br /> <br />200901234 <br /> <br />Residence <br /> <br />311 N LINCOLN AVE APT 6A <br />GRAND ISLAND, NE 68801-4776 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of thl3 lien isrefiled 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 Dal. for Unpaid Balance <br />Kind of Tax Endin, Identifying Number Assessment left n, of Assessment <br />(a) (b) (c (d) (e) { <br />1040 12/31/2005 XXX-XX-4259 09/18/2006 10/18/2016 <br />1040 12/31/2005 XXX-XX-4259 .. 03/24/2008 04/23/2018 3321.25 <br />1040 12/31/2006 XXX-XX-4259 04/15/2007 05/15/2017 <br />1040 12/31/2006 XXX-XX-4259 09/08/2008 10/08/2018 4214.73 <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 />7535.98 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />04 th day of February <br /> <br />2009 <br /> <br />the <br /> <br />for DEBRA K. HURST <br /> <br /> <br />Title <br />ACS <br />(800) 829-7650 <br /> <br />12-00-0000 <br /> <br />Signature <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien \ I / <br /> <br />Rev. Rul. 71-466,1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004) y.....--- ... <br />D3rt . IIiI 1Can.. Rv IP....ANI~..... NR.-a ._ ..'_:.. <br />