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<br />03/18/2009 WED 14:31 FAX 402 4714429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1dI0101010 <br /> <br />~Fo'" 668 (Y)(C) <br />(Rev. February 2004) <br /> <br />8801 <br /> <br />Department of the Treasury ~ Internal Revenue Service <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 522901409 <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 JAMA OBERMILLER <br /> <br />For Optional Use by Recording Office <br /> <br />NE See: of S-la-l:i! Jann A Gale.. uce FTL. <br /> <br /> <br />9909590444-8 ~9S: 1 <br />OBERMILLER JAMA <br />Filed: 03/18/2009 01:20 ~M <br /> <br />200901972 <br /> <br />Residence <br /> <br />2015 STAGECOACH RD <br />GRAND ISLAND, NE 68801-7357 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below. <br />unless notice of the lien is rafiled 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 IRC 6325(a), <br /> <br />Kind of Tax <br />a <br />1040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2007 <br /> <br />Identifying Number <br />(c) <br />XXX-XX-1863 <br /> <br />Date of <br />Assessment <br />(d) <br />11/17/2008 <br /> <br />Last Day for <br />Refiling <br />(e) <br />12/17/2018 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />158680.41 <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 />158680.41 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />the <br /> <br />06th day of March <br /> <br />2009 <br /> <br />for PATRICK J KELLOGG <br /> <br /> <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br /> <br />24-10-1744 <br /> <br />Signature <br /> <br />(NOTE: Certificate of officer authoriled by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien J <br />Rev, Rul. 71-466, 1971 - 2 C.B. 409) Form 668(y)(c) (Rev. 2~2004) <br />Pm , ...... By -. OK... CAT. NO 60025X . . <br />