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<br />04/08/2009 WED 15:56 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />~008/009 <br /> <br />\)\ <br /> <br />Form 668 (Y)(C) <br />(Rev. Februarv 20041 <br /> <br />8801 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br /> <br />~=~~~~~~::::32;r: :m~~:= ~ IIIJljilllmlli;~III~~I- <br />Code, we are....... anola.....1axes (1ncIudmg - ODd penaJdes) ....JJIIIIII <br /> <br />have been assessed against the followln."named taxpayer. We have made C1,.UB 89 INC 7'A CORPORATi:: 1 <br />a demand for payment'of this liability, but It remains unpaid. Therefore, FJLed: 04/08/2009 11:19 AM <br />there is a lien In favor of the United States on all property and ripts to <br />property belonelng to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br /> <br />Name of Taxpayer CLUB 69 INC , a Corporation <br /> <br />l.., <br /> <br />, . <br />j . <br /> <br />j. ". <br /> <br />1 . <br /> <br />; . <br />" <br /> <br />Residence <br /> <br />106 E 3RD ST <br />GRANDISLAND, NE 68801-5910 <br /> <br />20'0902616 <br /> <br />.. <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of tl18 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 e8 defined <br />in IRC 6325(a). <br /> <br /> Tax Period Date of Last Dr.. for U~id Balance <br />Kind of Tax. Ending Identifying Number Assess.nt Rift g . of Assessment <br />(a) , (b) (c) (d) ee) (f) , <br />941 06/30/2007 20-3658058 10/27/2008 11/26/2018 312.51 <br />941 09/30/2007 20-3658058 10/27/2008 11/26l2018 432.79 <br />941 12/31/2007 20-3658058 05/05/2008 06/04/2018 2449.83 <br />941 03/31/2008 20-3658058 10/27/2008 11/26/2018 856.57 <br />941 06/30/2008 20-3658058 10/13/2008 11/12/2018 1392.74 <br /> <br />.~ . <br /> <br />:,r . <br /> <br />: ", <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 688Q2-1692 <br /> <br />Total $ <br /> <br />5444.44 <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 />Signature <br /> <br />Title <br />RBVENUE OFFICER <br />for DANIELLE L MUELLER (402) 437-5462 x2912 <br /> <br />(NOTE: Cenlficate of officer authorized by law to take acknowledgment is not essential to the validitY of Notice of I1lderal Tax lien <br />Rev. Ru/. 71-466, 1971 .2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004) <br />Part' . Kept By ReconIin, Oflice CAT. NO 60025X <br /> <br /> <br />~' <br /> <br />24-10-1720 <br /> <br />v <br />