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<br />03/18/2009 WED 14:31 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121006/010 <br /> <br />\9 <br /> <br />8801 <br /> <br />Form 668 (Y)(C) <br />(Rev. February 2004) <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: (BOO) 913-6050 521990209 <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 TIMOTHY G DAUGHERTY <br /> <br />For Optional Use by Recording Office <br /> <br />~I[l I rll'lIlt lllrlt I <br /> <br /> <br />9909590440-0 Pgs: 1 <br />DAUGHERTV TIMOTHV G <br />Filed: 03/18/200901,20 PM <br /> <br />Residence _ <br /> <br />924 W 7TH ST <br />GRAND ISLAND, NE 68801-4102 <br /> <br />200901968 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given hi 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 /> Tax Period Date of Last Dalu for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refi mg of Assessment <br />(a) (b) (c) Cd) (e) (f) <br />1040 12/31/2003 XXX-XX-4677 11/05/2007 12/05/2017 2494.78 <br />1040 12/31/2004 XXX-XX-4677 11/05/2007 12/05/2017 24014.85 <br />1040 12/31/2005 XXX-XX-4677 04/07/2008 05/07/2018 1589.13 <br />1040 12/31/2007 XXX-XX-4677 11/17/2008 12/17/2018 8535.19 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />, <br />Grand Island, NE68802-1692 <br /> <br />Total $ <br /> <br />36633.95 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />the <br /> <br />04 th day of March <br /> <br />2009 <br /> <br />for WILMA K PONTE <br /> <br /> <br />Title <br />REVENUE OFFICER <br />(30B) 384-4850 <br /> <br />24-10-1739 <br /> <br />Signature <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. Ru!. 71-466, 1971 ,2 C.B. 4091 Form 668(Y)(c) (Rev. 2-2004) <br />Part 1 . Kept By Recordin. OffIce CAT. NO 60025X <br />