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<br />Farm CCO _ Department of the Treasury -Internal Revenue Service <br />(Rev.septembert8781: Notice of Federal Tax Lien Under internal Revenue Laws <br /> <br />l._:_ <br />OlstliCl Serial Number for Optional use by Feeading O/Nce <br /> 42104 <br />~~ 47 <br />As provided by sections 6321, 6322, and 6323 of the Internal Revenue Code, <br />notice is given that taxes (including interest and penalties) have -been <br />assessed against the following-named taxpayer Demand for payment of <br />this liability has been made, but it remains unpaid. Therefore, there is a lien <br />i <br />o <br />rt <br />lo <br />i <br />il <br />rt <br />d <br />ht <br />t <br />b <br />t <br />i <br />2 --f) 9 4918 <br />g <br />pe <br />y <br />ng <br />ng <br />prope <br />y an <br />r <br />s <br />o pr <br />e <br />es on a <br />in favor of the Un <br />ted Sta <br />to this taxpayer for the amount of these taxes, and additional penalties, $ <br />interest, and costs that may accrue. <br />Name of Taxpayer <br />Clayton Petersen, Incorporated (a corporation) <br />Residence <br />373 North Vine <br />Grand Island, Nebraska 68801 <br /> Unpaid Balance <br />Kind of Tax Tax PeNad Ended Date of Assessment Identifying Number of Assessment <br />(a) fb) (c1 (d) (e) <br />941 .-~ of 8103 08..09-~SZ BriF 47-~5z44zz 5:957.02 <br />941 -, 01 8106 os-o9..a2 Brig 47-AS~z g,653.6i <br />941 ..- 01 8109 0&-o9~6z Btu' 47~Sz4422 8,474.94 <br />941 ~- 01 8112 0809-$2 BMF 47--05241+22 8, 296. T9 <br />941- ~-. 01 8203 08~o9-~BZ Brg' 47524422 7,41+1.67 <br />mace of t-nmg Register of Deeds <br />Couzsty of Hall Total S 38, 823.39 <br />Grand Island,- Nebraska 68801 <br />This notice was prepared and signed at Csand Island, Nebraska ,on this,. <br />the Sth day of November tg 82 <br />Signature _ ~ Title <br />L~ <br />z er ~ ~' Revenue Officer <br />{'~'^a. Certificate o/ of/icar authorised by !a t take acknowledgments is rtof essential fo the validity of Notice o/ <br />Federal Tax Lien G.C.M. 26119, f95Q~1, C.B. 125.) <br />Rart 1 - To t1e kept by recording office Form fi88 (Rev. 9-78) <br /> <br /> <br />L._.. <br />