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i ~ ) ponart mast otthe Treasury _ istemat AsvsnueServxCe <br />Fc?rrn 1111 ~j ~~} a~. ~q~ LS j~! Q/~~j~ +~y p/~ t~ ^ a~$II a!~+y! $~~p p ~y{a~ <br />i P,ev; £eRtkriiDer T!~78)~ ~tiFlrlls~: {~1 ~NY~ts W ~i~A':: ~gft V~~~`'. ~~#Lfi~19R~# ~~i.~ia~~W. ~ia Y#~.. <br />di^aiT'Ct --iS@ria1 ~(LtRIRRr For Optfnrtat Usa:DY R~D~trtg0lffcs <br />,~; I aeaze <br />As praiided b?~ sections fi92t, 8'i.22, and 8323; of. the Internaf RBVeAUB Cade, ~~ ~ <br />~„ <br />~ <br />notice Is giver ita* taxes (iricludmg interest and penalliesl have been assessed V ~ ® <br />} ~ <br />V sJ <br />agarrst Yh© fcl!awinga~aemed Eaxpa}rer. {?emafld ior-taaymeht of'thas fiabilaty has <br />beAn made, but it re:rra}rf5 unpEfd. 'Fharefnre: there ~s a tieR in favor of the ilnited <br />States nn al! C~raAertY and rights to property beiongtrtg to this faxpayer fes the <br />amount of these taxe,, 3rsd additional penalties, interest; and cosfs that Rsay <br />accrue. 1 <br />i <br />1Vame Gf T3xpayer <br />I.8F2y'Fii•. sad. '~` 38siOS~ Es BOBSess.. <br />FteSidef!Ce <br />ut~barrel RCaAd <br />C~and Lsland~ Nebraska 68801 <br />~ URpaW fjalattce <br />!(ktd of Tax 'Tax. Period ER~ded t9ate of llssesrkreert , Itft9intlfying Number of As~smsRt <br />- (ai SD3.- ~ ic7 td7 !el <br />-- <br />- <br />i0~.0 - 30 i <br />,7722 ~ 02.-09-81. ZMF' 505-=s6 5~-~ _ <br />3~8Q1.63 <br />040 ~-- 30 7812 ~ 02-~9-$1 ~ ~k° 505-~6-54~Q i, ~ •37 <br />9 <br /> <br /> <br /> <br /> <br />. ~ <br />f <br />z <br />~ <br />I <br /> <br />III{~ <br /> <br /> <br /> <br />~ <br /> <br />, <br /> <br /> <br /> <br />i <br />i~sace of Filinq Register cf .Leda ~ - <br />Covnty ~i' Ha31 3.ota1 <br />' 3 5,?7k.0U <br />wand ? slaras3r Nebraska 688( <br />11 I <br /> <br />T*«s notice was ~Par~ed ar,d aign~~t` t~ra~d. Island' Plebi°ssisa . on #ltxs, <br />the i9th day Qf ._.Janus~ ,}g, <br />Sign re (; f ` _ ~ Fade <br />~` ,-~ ~ ~ <br />_ eI rte ;Revenue Officer <br />;7i`iN: CGrt~I!i a~N _r tilx.,er n~ harrze~ oy }gw to YsAe.. ACknowNQpmgnl5 is not aSaBfiftBl t0 tAd ub7WMY ol,:.HOVtpa.:. U- . <br />retiarai`dx iro^ 1}-C_N. ?u4; Y, 145?(, x' c..,.:2$.) <br />Part 3 - To be fc~t by r9ecortting ©ffitm Form B~$ (Rev. 9-76) <br />I <br /> <br /> <br />