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Forrn~~~ t?oPSrtmenl a2tihe.TreesurY-4nlefnM Revenue 5ervlca. <br />i,Rev. 8aclam0ert9^87~ Nance of .Federal Tax Lien Under Internal Revenue laws <br />Eks'ric! ~Seriai Number ~ For ooroner uao av axoramq Anita <br />E'l~AHk k7 J _ 4118b `_ { <br />As.provded by sections 6321. 6322, and 5323 of tho Internal Revenue lode. <br />notice is grv~en I;hat taxes rinciuding interest and penalties) have been assessed <br />. ~+agaittst'the follawsng-named taxpayer. demand for payment of this liability has i ~~ ~ ~~ ~ ~ ~ ~ ~. <br />beeninade. but ii remains unpaid. Therefore, there is a lien in favor of the United ~I 1 <br />Sta+cl~ en a}t property and rights io proper*y beiongir~g to this taxpayer for the <br />:: an-count of tfi9lrb taxes, ano additional penalties, inttrresi; and costs that may ; <br />a.crue. r <br />x. Name of TatepaYer-- -- -- ~--- <br />Gene R. Cam or. <br />Residence -_-- ------- ----- ----- <br />703 ~r. 16tH <br />Grand Islend~ Nebraska 53301 ~ <br />~ ~ UnpaW Halsnee <br />KinO d Tas- ; Tu Period Ended ! Dste of AssessmMt tdentitytng Namhx ~~~ of Assessment <br />¢3 ~- !ut ~ m3 ! lei ~ ie1 <br />10t,0/3o ` 7912 ~~3-29-~?2 ~ a~ 505-~-517~~-- ~- X63.67 <br />102~D~~0 t 3012 ;` '-~'7~~5~2 ~ ~' 505-2217; I 939.69 <br />Ptace of Fitfng - -~ - <br />Regitstnr of -eeds <br />County of Hall Told i i 1, c"~ , jb <br />Grand Island, Nebraska 6RSJ1 <br />This no±tce was prepared end signed at _ __ Grand Island) ~+ebrasKa <br />the tr_ day of Ju~_ <br />Signature ~--------- <br />Lyle -. Metzger /x <br />tao,.; cr~,,~.r. ~ o;,~, <br />FrOrraf ?ar trwz G_C.M. 26& <br />on this, <br />~ ~~. Tit',e <br />(~ ~ ~ Rev xiue Offioer <br />61GCnze^n 5V ~ r a„kROwFsdy mr nn's ~ nc. e,. ar,Gul .~ the veh~.'.y or NrXme o_ <br />Pact 1 - To be kepi by recording office rror;n 66@ iRev s-Tat <br /> <br /> <br />