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<br />05/15/2009 FRI 14:33 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121003/006 <br /> <br />QO <br /> <br />Form 668 (Y)(c) <br />"",,, (Rev. February 20041 <br /> <br />8801 <br /> <br />Department of the Treasury - Internal Revenue Service <br /> <br />Notice of Federal Tax Lien <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit PhoRe: (SO<l) 913-6050 543205809 <br /> <br />As provided by seedon 6121, 6322, and 6323 of the Internal Revenue <br />Code, we are livin, 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 COFFEE N CREAM INC , a Corporatlon <br /> <br />For Optional Use by Recording Office <br /> <br /> <br />9909!596706-0 Pgs, 1 <br />COFFEE N CREAM INC R CORPORA <br />Filed: 05115/2009 09:39 A" <br /> <br />Residence <br /> <br />1247 N BURLINGTON AVE <br />HASTINGS, NE 68901-3011 <br /> <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (el. this notice shall. <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(al. <br /> <br />200903781 <br /> <br />Kind of Tax <br />a) <br />941 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2008 <br /> <br />Identifying Number <br />(c) <br />71-0937456 <br /> <br />Date of <br />Assessment <br />(d) <br />04/06/2009 <br /> <br />Last Day for <br />Refillng <br />(e) <br />05/06/2019 <br /> <br />Unpaid Balance <br />of Assessment <br /> <br />1053.81 <br /> <br />~ <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 />1053.81 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />. on this. <br /> <br />the <br /> <br />04th day of May <br /> <br />2009 <br /> <br />Signature <br /> <br /> <br />Title <br />REVENUE OFFICER <br />(402) 437-5462 <br /> <br />24-10-1721 <br /> <br />for ERIC MARTIN <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. Rul. 71-466. 1971 ~ 2 C.B. 4091 <br /> <br />Part . - Kept By Recording Office <br /> <br />Form 668(YHc) (Rev. 2-20041 <br />CAT. NO 60025X <br /> <br />'-I' <br />