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r- <br />gapaKmar+~ of ehe Treasury - Internal Revenue8eroice <br />Forn ~~ I <br />,Ap, ~~1zm~„s,e Notice of Fetleral Tax Lien Under internal Revenue Laws <br />t3tsR lit i $erfalt~Umbr.`r For Optlonel use ny Rnc ora'Ing Orfico <br />41185 <br />~;-C1~~a ---- -'~-- -----~--- - -- -- <br />As otovided by sections 6321, 6322. and 1.0323 of the Internal Revenue Code. I <br />notice is given that taxes inc.uding interest and penalties have been assessed <br />a~.,2if)st he foltowm~-named taxpayor. Demand for payment of This liability has ' , ~} t„ <br />teen ~<ade, but It rFrinains unpaid Fhe:efore, there is a lien in favor of the UntecS ~ ~~ ~ ~~ ~ J ,! <br />51ate~~ :,r~ all property and rights to property betenglrg to thi^, taxPalter far the <br />famo,Fnt of tt;~? ;axes, and additlrna! penalties, interest, and costs that may <br />~~-BCO(Ue. - ~I <br />N~e~t7axpaYer ---- ------------- <br />American Erter~ 3alers Tnccrpcrated <br />a o oration <br />Residence <br />912 daint Paa1 Road Posr, Cff~ce pox 142 <br />+".rrand Island, Ne`oras?;a 5~?£i01 . <br />~-~---~r UnpaW BatanCs <br />Kind al Tas Taz Period Ended Date of Assessment I ldenlifying 4umber o1 Assessment <br />(e) ~ :nl ,., __. ~ rep <br />---94I-U1----$uz ------ ~-10-~2~~"r Y7-O5$1r+%+9 759.21 <br />I i <br />i <br />t I <br />r <br />1 <br />i <br />E <br />t~aca ct Flnng 3egistez~ e° t3eeds - - .- <br />Count y o; ~a.il Total i 3 7 59.21 <br />':,rand Island, ;:ebraska 6801 <br />This notice wis5 ~evarc-d and sisned of _:`~~±T~d _Is~and~t~elarGska _. - _ _--_--- _-__ _ _.._, on this, <br />the $th _ day ct Jt1I~-- •,a $2 ----_ <br />Signatur . itle <br />3~ai ha81' orrte Reverrae ~ff~~er _` <br /> <br />y, i <br />ChOt~: cr:;, ~.c.aru o. .~rrce~ arnw;rc<r r~ a~n nc.,,o»;..cp.T~e~u .. ~.~. e~-.o~.,_ o irce ~avia~ry rn .+orKe u. <br />. .u:a~ 7as ~.:ar. 'v.-_~A-25A; B. 79514:, n. 5. `~5~ <br />Part 1 -- Tq be kept by recording office Form 668 (Rev. &~6i <br /> <br /> <br />