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<br />04/30/2009 ~HU 14:38 FAX 402 471 4429 UCC SECRE~ARY OF S~A~E ~~~ Hall <br /> <br />1dI002/003 <br /> <br />0" <br /> <br />Fonn 668 (Y)(c) <br />IRev. Februllry 20041 <br /> <br />8801 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Uen <br /> <br />I <br />~...... <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Uen Unit Phone: (800) 913-6050 538199709 <br /> <br />As provided by section 6321, 6322, and 6323, of the Internal Revenue <br />Code, we are eMng 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 ANGEL L COLON MENDEZ <br /> <br />For Optional Use by Recording Office <br /> <br /> <br />I'YL <br /> <br />9909595123-3 PSIS: 1 <br />COLON MENDEZ ANGEL L <br />Filed: 04/30/2009 10:39 AM <br /> <br />Residence <br /> <br />518 W 1ST ST <br />GRAND ISLAND, NE 68801-5803 <br /> <br />200903269 <br /> <br />IMPORTANT RELEASE 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(a). <br /> <br />Kind of Tax <br />(a <br />1040 <br />1040 <br /> <br />Tax Period <br />Endlnl <br />b) <br />12/31/2003 <br />12/31/2004' <br /> <br />Identifying Number <br />c) <br />XXX-XX-6531 <br />XXX-XX-6531 <br /> <br />Date of <br />Assessment <br />(d <br />03/26/2007 <br />10/29/2007 <br /> <br />Last Day for <br />. Reflllng <br />e <br />04/25/2017 <br />11/28/2017 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />15573.20 <br />22192.50 <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 />37765.70 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />20th day of April <br /> <br />2009 <br /> <br />the <br /> <br />Signature <br /> <br /> <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br /> <br />24-10-1739 <br /> <br />for WILMA K PONTE <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. 409) Form 668(Y)(c) IRev. 2-2004).1/ <br />Part I - Kept By Recordin, Office CAT. NO 60025X \[. <br />