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<br />02/19/2009 THU 15:18 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1dJ005/005 <br /> <br />~ <br /> <br />o Form 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 />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 514512509 <br /> <br />A5 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 JESUS E GARCIA ROSARIO <br /> <br />For Optional Use by Recording Office <br /> <br /> <br />9909587442-9 <br />GRRCIA ROSARIO JESUS E <br />Filed: 02/19/2009 10:51 AK <br /> <br />200901235 <br /> <br />Residence <br /> <br />1407 W NORTH FRONT ST <br />GRAND ISLAND, NE 68801-4749 <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 suph 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 />12/31/2003 <br /> <br />Identifying Number <br />(c) <br />XXX-XX-2046 <br />XXX-XX-2046 <br /> <br />Date of <br />Assessment <br />(d) <br />04/09/2007 <br />04/09/2007 <br /> <br />Last Day for <br />Refillng <br />e <br />05/09/2017 <br />05/09/2017 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />8419.61 <br />13771.41 <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 />22191.02 <br /> <br />This notice was prepared and signed -at <br /> <br />CHICAGO, IL <br /> <br />/ on this, <br /> <br />the <br /> <br />04th day of February <br /> <br />2009 <br /> <br />for WILMA K PONTE <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 validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466,1971 - 2 C.B. 409) <br /> <br />Part. j. Ie_, Rv R..,.A....'.... nw..... <br /> <br />Form 668(Y)(c) (Rev. 2-2004) <br /> <br />~-; <br />