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<br />05/06/2009 WED 15:12 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />~t? 8801 <br /> <br />!lI005/009 <br /> <br />Form 668 (Y)(c) <br />IR8~ ,Fabruary 2004) <br /> <br />Department of the Treasury - Internal Revenue Service 20 0 9 0 3 5 0 1 <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 539892309 <br /> <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are ,ivin, 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 mayaccrue. <br /> <br />Name of Taxpayer HERBIE RIVERA <br /> <br />For Optional Use by Recording Office <br /> <br />11111111)1 <br /> <br /> <br /> <br />RIVERA HERBIE Pes; 1 <br />FLIed; 05/06/2009 10:34 AM <br /> <br />Residence <br /> <br />PO BOX 2496 <br />GRAND ISLAND, NE 68802-2496 <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 /> Tax Period Date of Last Dal. for Unpaid Balance <br />Kind of Tax. Ending Identifying Number Assessment Refi Ing of Assessment <br />(a) (b) (c) (d) (e) (f) <br />1040 12/31/2003 XXX-XX-8951 06/04/2007 07/04/2017 3365.65 <br />1040 12/31/2004 XXX-XX-8951 06/04/2007 07/04/2017 11193.27 <br />1040 12/31/2005 XXX-XX-8951 05/05/2008 06/04/2018 6254.57 <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 />20813.49 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />. on this, <br /> <br />23rd 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 />24-10-1744 <br /> <br />for PATRICK J KELLOGG <br /> <br />(NOTE: Certificate at officer aulhomed by law 10 take acknowledgment is not essential 10 the validity of Notice or Federal Tax hell " <br />Rev, Ru!. 71.466,1971 . 2 C,B 409) Form 668(Y)(c) (Rev. 2.20041('\ ~ J <br />Parr I . Kep[ By Recordinr Office CAT. NO 60025X { \.\ <br />'.J <br />