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<br />05/12/2009 TUE 14:17 <br /> <br />FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />~004/006 <br />200903650 <br /> <br />8' <br /> <br />8801 <br /> <br />Form 668 (Y)(c) <br />IRev. Februarv 2004) <br /> <br />Department of the Treasury - Internal Revenue Service <br /> <br />Notice of Federal Tax Lien <br /> <br />Area: Serial Number <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone: (800) 829-7650 542753309 <br /> <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving 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 DALE A MICHALSKI <br /> <br />For Optional Use by Recording Office <br /> <br /> <br />Residence <br /> <br />308 E 15TH ST <br />GRAND ISLAND, NE 68801-2514 <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 /> <br />Tax Period <br />Ending <br />(b <br />12/31/2002 <br /> <br />Identifying Number <br />(c <br />XXX-XX-9290 <br /> <br />Date of <br />Assessment <br />(d) <br />04/30/2007 <br /> <br />Last Day for <br />Refiling <br />(e) <br />05/30/2017 <br /> <br />Unpaid Balance <br />of Assessment <br />(f) <br />10380.39 <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 />10380.39 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this. <br /> <br />Olst day of May <br /> <br />2009 <br /> <br />the <br /> <br />Signature <br /> <br /> <br />Title <br />ACS <br />(800) 829-7650 <br /> <br />12-00-0000 <br /> <br />for DEBRA K. HURST <br /> <br />(NOTE: Certificate of officer authorized by law [0 take acknowledgment is not essential [0 [he validity of Notice of Federal Tax lien <br /> <br />Rev. Rul. 71-466, 1971 . 2 C.B. 409) Form 668(Y)(c) IRev- 2-20041 <br />Part t . Kept By Recording Office CAT. NO 60025X <br /> <br />\/ ! <br />\ . <br />