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<br />04/08/2009 WED 15:55 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1ZI0 0 5/ 0 0 9 <br /> <br />b4; <br /> <br />Form 668 (Y)(c) <br />CRtv. 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 />WAGE & INVESTMENT AREA #2 <br />lien Unit Phone: (800) 829-7650 529535009 <br /> <br />A5 provided by section 6321, 6322, and 63.23 of the Internal Revenue <br />Code, we are givlnl a notice that taxes (includlnl interest and penalties) <br />have been assessed apinst the followl.....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 belonginl to this taxpayer for the amount of theSe taxes, and <br />additional penalties, interest, and costs that may accrue. <br /> <br />Name of Taxpayer RAY L GATZEMEYER <br /> <br />For ODtional Use by Recording Office <br /> <br />Fllfld~E~i'0:7Y l Pss: 1 <br />200911:19~ <br /> <br /> <br />Residence <br /> <br />637 KENNEDY DR APT 1 <br />GRANp ISLAND, NE 68803-3447 <br /> <br />200902609 <br /> <br />IMPORTANT RELWE INFORMATION: For each assessment listed-below, <br />unless notice of the lien is refiled 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(8). <br /> <br /> Tax Period Date of Las~ for Ul)paid Balance <br />Kind of Tax Endinl Identlfylnar Number Assessment oar of Assessment <br />(a) b) (c) d <e) <br />1040 12/31/2002 XXX-XX-3452 09/10/2007 10/10/2017 2191.34 <br />1040 12/31/2004 XXX-XX-3452 09/03/2007 10/03/2017 1858.72 <br />1040 12/31/2005 XXX-XX-3452 0.9/03/2007 10/03/2017 2848.82 <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 />6898.88 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />27th day of March <br /> <br />2009 <br /> <br />the <br /> <br />for DEBRA K. HURST <br /> <br /> <br />Title <br />ACS <br />(800) 829-7650 <br /> <br />12-00-0000 <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. Rul. 71-466. 1971 - 2 C.B. 409) Form 668(Y)(c) lRev. 2.2004) \\ / <br />Part . . Kept By RecordJn. Offke CAT. NO 60026X " <br />