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<br />Form ~~ <br />{Rev. ScPWmt)er <br />DspPrtnOnr oP".hg Tr984ury-ln4emal.RgvenueSeavice <br />I~lotice~ of~\~edera! Tax Lien E3nder ftrternal Revenue Laws <br />~ut((~t igerla(t1u((iq~e( For OPrlona! fJSa oY Rx::rh^ng Office <br />~SA.IiA ~; 4 40652 <br />-- <br />~~ "-- <br />As provided '.~y sections 6321, &322, and 6323 of the, fnternsl Revenue Code. Z~ ~ .~ ~ j <br />not;ee fs givzn tha*, taxes ~inclt~ding interest and penalties) have been assessed <br />ariainsi the fallowing-named t~paYar. Demand far payment of this ligbifity has <br />seen made, I~ui it remains f~npaid. Therefore, !here is a Tien in favCr c>f the United ' <br />States an at1 properry and rights to proper*•: belonging to this iaxp8yBr for the.: i <br />amount at these taxes: ands-additional penalties, interest, and costs °th8t may. I <br />aCCrl1S. <br />Nitme of TarcpaYBr j <br />I.ex2y C . 0?.an <br />Sa. Locusi, ICS <br />iiesidence t <br />b31 $ iACtL:,t'. Jt:. .. <br />4:rSfilC I91Nnd tie hg~3~. 3 <br /> Unpaid ~ <br />Kind d Ta: ~ Tu PMrbd Endsd ~ Data d AsgsmNM ~ ld~ntily6n9 Nu mper at ltssaasrnent <br />!•I i fbl <br />- <br />- <br />--- <br />-~ <br />9k.1 - G1 ---- <br />~~~,-. _ f33-2~3-~82 ~ ~.7-t~Fs23~8 9h79.G9 <br />~ - of ~ 22-32-52 ~ c~3-~'2.-82 ~ M <br />} <br />{ <br />l <br />r 187.35 <br />! ~ <br />} 4 <br />1 <br />d <br /> <br />' <br />t. <br />t <br /> <br /> <br />. <br />I <br />i, <br />j <br />.Race vt Fpirhp Ra$taGer of D-~ds <br />County ,02 6iai1 Taal .` i 9g4G.44 <br />4T811C~ Ial&t]d.~ lt~TJrnska E~F38C)1 <br />Tfii'6 nOt4fCQ waf 1 #R1Q Si(jtsllQ 81 Gr~ <br />the _ 2~ h dfil aM ~Y ~ . t 9 _S2 <br />Nebraska <br />Title <br />jZever.:ie. Officer <br />on this, <br /> <br />Chtws e«-•r.en• ~r mwe.r eM„.:- ~ ~_ ~ ...• .«..~:.aa.nru rs.. n« .ssa++nn _ rn. wan„y a Ncw,cr or <br />F~•r•r '•i tr•n t'i ~ M..L~. D. ~~.'»e ~ Ur ~ 23 7 <br />Pat i - To bs kspt bY.rstx3rQEng:office Fwm 661i 4Rev 37&? <br /> <br /> <br />