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<br />04/15/2009 WED 12:25 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall
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<br />Form 668 (Y)(c)
<br />(Rev. February 20041
<br />
<br />8801
<br />
<br />Department of the Treasury ~ Internal Revenue Service
<br />Notice of feclerat Tax: Uen
<br />
<br />2009028~'8
<br />
<br />~IJ:\'-
<br />
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<br />
<br />Area: Serial Number
<br />WAGE & INVESTMENT AREA #2
<br />Lien Unit Phone: (800) 829-7650 533102409
<br />
<br />A& provkled by section 6321, 6322, and 6]2] of the Internal Revenue
<br />Code, we are alvin, a notice that taxes (Includln,lncerest and penalties)
<br />have been assessed apinst the foUowIns-named taxpayer. We have made
<br />a demand for payment of this liablUty, but It nmalns unpaid. Therefon,
<br />there is a lien in favor of the United States on aU property and rJahts to
<br />property belongin, to this taxpayer for the amount of these taxes, and
<br />addkional penaldes, interest, and costs that II1Q' accrue.
<br />
<br />Name of Taxpayer, JOSE MELENDEZ MATOS
<br />
<br />For Optional Use by Recording Office
<br />
<br />Illlfll"JI
<br />
<br />PU:lTOS JOSE MELENDEZ Pgs: 1
<br />FLIed: 04/15/2009 11:01 AM
<br />
<br />Residence
<br />
<br />116 Me HIGHWAY 30 LOT 18
<br />GRAND ISLAND, NE 68801-9049
<br />
<br />'IMPORTANTRELEASEINFORMATlON: For each assessment listed below.
<br />unless notice Qftl)8' li~"..!~)'.fJle~ I;)V. the d.8te given in column (e). this notice shall. ,
<br />on the dayf~lIciwing ,such~date, operate as a certificate of release 8S defined
<br />in IRC 6325(a). : ' . ,
<br />
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<br />" " " , ' Tax. Period
<br />Kind of Tax " .,: ,End~... " ,Idelitifyin, Number
<br />,(a)Cb) (c)"
<br />10-40",:' ',i'2'taJI2Qo.o' ~" ~-XX-7~99
<br />. 1040: : ,l~l31l:i6oi ", 'JOCX-xX-7999
<br />1040" ': '1'~lj];f2002 XXX-XX-7999
<br />1040, . 12:;l3'i 12,(} 04 XXX:"XX-7999,
<br />1040' "1'2l31'/2005XXX"':'XX-7999
<br />1040 i~131l2'q05 xxx-xx"'" 7999
<br />
<br />,Date Of
<br />Assessment
<br />Cd)
<br />
<br />07/31/2006
<br />07/31/2006
<br />07/31/2006
<br />04/15/2005
<br />04/15/2006
<br />07/23/2007
<br />
<br />",~:ru,.::
<br />eel",:',:,'..
<br />08/30/2016
<br />08/30/2016
<br />08/30/2016
<br />05/15/2015
<br />05/15/2016
<br />08l22/2017
<br />
<br />, .U~ald .Balance
<br />,,:,':,:Of~~:,,',
<br />9055.57,
<br />17797. ~lO'
<br />5667.90
<br />3130..40
<br />
<br />27919.9.7 "
<br />
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<br />
<br />Place of Filing
<br />
<br />'R~gister of Deeds
<br />Hall..POBOX.1692
<br />Grand Island, NE 68802-1692
<br />
<br />Total $ ',,"
<br />
<br />63570'~ 84
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<br />'This ,notic,e wasPiepare~:' and 'Signed at
<br />
<br />CHICAGO, IL
<br />
<br />! _onthi~" ..
<br />
<br />the
<br />
<br />07th day of' April
<br />
<br />2009
<br />
<br />Signature
<br />
<br />Title
<br />ACS
<br />for DEBRA ,K. HURST (800) 829-7650
<br />
<br />(NOTE:eertificat8'of officer authorized by law to taka acknowledgment is not essential to the vali~ityQf Notice of Federa, I Tax lien '::-'\
<br />Rev. Ru!' 71-466,1971 .2 C.B. 4091 Form '68mee) (Rev. 2-200~\\J
<br />, Pan 1 - Kept By RecordI.!J Oftice ' CAT. NO 60025X .
<br />. ' '. \
<br />
<br />
<br />12-00-0000
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