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<br />03/13/2009 FRI 13:08 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121002/006 <br /> <br />o Form 668 (Y)(c) . <br />(Rev. February 2004) <br /> <br />8801 <br /> <br />Department of the Treasury - Internal Revenue Service <br /> <br />Notice of Federal Tax Lien <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 521294809 <br /> <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that taxes (including interest and penalties) <br />have been assessed against the fOllowing-named taxpayer. We have made <br />a demand for payment of this liability, but It remains unpaid. Therefore, <br />there is a lien. in favor of the United States on all property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br /> <br />Name of Taxpayer COFFEE N CREAM INC , a Corporation <br /> <br /> <br />"Tl <br /> <br />9909589811-4 PSIS: 1 <br />COFFEE N CREAM INC . A CORPORA <br />Filed: 03/13/2009 09:20 AM <br /> <br />200901859 <br /> <br />Residence <br /> <br />1247 N BURLINGTON AVE <br />HASTINGS, NE 68901-3011 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refired by the date given in column (e), this notice shall, <br />on the day following. such date, operate as a certificate of release as defined <br />in IRe 6325(a). . . <br /> <br />Kind of Tax <br />(a) <br />941 <br /> <br />Tax Period <br />.Ending <br />(b) <br />09/30/2008 <br /> <br />Identifying Number <br />(cr <br />71-0937456 <br /> <br />Date of <br />Assessment <br />(d) <br />02/02/2009 <br /> <br />Last Day for <br />Refiling <br />ee) <br />03/04/2019 <br /> <br />Unpaid Balance <br />of Assessment <br />(0 <br />4358.81 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand ISland,NE 68802-1692 <br /> <br />Total $ <br /> <br />4358.81 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this. <br /> <br />the <br /> <br />02nd day of March <br /> <br />2009 <br /> <br />Signature <br /> <br /> <br />Title <br />REVENUE OFFICER <br />(402) 437-5462 <br /> <br />24-10-1721 <br /> <br />for ERIC MARTIN <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004) \ U <br />Pan 1 . Kept By Recordlh' Office CAT. NO 60025X '{ <br />