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<br />02/20/2009 FRI 15:02 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1dJ002/002 <br /> <br />D1, <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 515737909 <br /> <br />As provided by section 6321, 6]22, and 6]2] 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 thac may accRle. <br /> <br />Name of Taxpayer DENNETA M ~INGINSMITH <br /> <br />~ l~rnllll'l"r II <br /> <br />9909587562-3 PSIS' 1 <br />KLINGINSMITH DENNETA M <br />Filed, 02/20/2009 09:22 AM <br /> <br />Residence <br /> <br />200901264 <br /> <br />1621 HAGGE AVE <br />GRAND ISLAND, NE 68801-7446 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refired by the date given in column Ie), 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 />Kind of Tax <br />(a) <br />1040 <br /> <br />Tax Period <br />Ending' <br />(b) <br />12/31/2006 <br /> <br />Identifying Number <br />(c) <br />XXX-XX-0722 <br /> <br />Date of <br />Assessment <br />(d) <br />01/05/2009 <br /> <br />Last Day for <br />Reflllng <br />(e) <br />02/04/2019 <br /> <br />Unpaid Balance <br />of Assessment <br />(0 <br />164.03 <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 />164.03 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />the <br /> <br />09th day of February <br /> <br />2009 <br /> <br />Signature <br />for DANIELLE L MUELLER <br /> <br /> <br />Title <br />REVENUE OFFICER <br />(402) 437-5462 x2912 <br /> <br />24-10-1720 <br /> <br />(NOTE: Certificate of officer authoril~d by law to take acknowledgment Is not essential to the validity of Notice of Federal Tax lien , j' <br /> <br />Rev. Ru!. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) IRev. 2-2004) \V- <br />D3.... .. _ 1(..... Ru DAIOft.dZ...,... -"In~A <br />