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°orm ~`CO , ; ~ O~partmenc c~fahe7reasury-infernal Revenue Service ' (Rev. septen,ear,~ ~ , Notice of Federal Tax Lien Under internal. Revenue Laws -- 1 DI3/rift - " Serial NUmb@f Foy Gp7~^naf Use by F+ecor~ing O!lice ~--- _ 41545 - Naha -- As provided dy sxtions 6321, 6322, and 6323 of the Internal Revenue Code, notice is giver. that taxes (including interest and penalties) have been assessed agairtst ,tke tolfowing-named taxpayer, Derttand for payment of this liability has been made; trut it rer~~ains unpaid. Theretore, there is a lien in savor of the United States on ail property and rights to property belonging " j ~ ~ 3 ~~ (! additional penalties, to this taxpayer for the amount of these taxes. and S 2 ~ ~ . interest, and costs that may accrue. Name o! Taxpayer Clint Onne n Tri St-.ate Trar>Jrnissirn Residence rth Itirr>~a l all No l ,~y ~~ ~ l~.., ry~ r Island, ~'1GSJrd.GM G.00~/1 Uropaid Balance Kind d Tax Tax PMod F_ndW Oab of AssassmMt i Identifying Number of AasNarfNnt (~j 2+1 fc) i (d7 (e1 941 - O1 03/31/90 I 09/15/80 ! 47-0620009 B[4c' 1,811.28 941 - O1 06/30/80 ~ 09/22/80 ~ 47-:520009 H~iF 2,115.18 941 - O1 09/30/80 I 12/22/80 I 47--0620009 &'~ff' 2, 254. E2 941 - O1 06/30/81 ~ 11/23,81 47-0620004 i~ 1,773.67 941 - O1 09/30/81 03/29/82 47-0620009 tom' 1,694.40 941 - C1 12/31/81 OSj10/82 4i-0620009 F3~ff' 139.99 940 - 10 12/31/80 05/10/82 47--0520009 131F' 102.99 Place of Fllirp Registez of De~cis Full (Almty Tolal i 9, 89l. 33 Lund Island, 23ebras};a- 68801 Thfa notice waa prepared and s+flned a! ~a~, ~~~ ,on this, ina__l$.~klday of Aucust ,,g 82 Sipnalure _ ,~ ~- / L_ t ~~~1~~~ C1rt11icfN of e~'~~ar sufrmzeQ Dy ~aw~7~ race ackrrowrWpments ~i not esavn!ra! ro the valitlrty o/ Notice of FaC-ral Tax Uan G.C.Y. 2:w 7A, t950~;, C9. 725.) Part 1 - To by kept by racordlnp offiq t=erm ese (Rev. s-78)