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05/20/2009 WED 15:15 FAX 402 471 4429 UCC SECRETARY OF STATE ~-~~ Hall <br />8801 <br />QForm b68 (Y)(t) <br />IHev. February 2004} <br />Area; <br />PTAGE & INVESTMENT AREPi, #2 <br />Department of the Treasury -Internal Revenue Service <br />Notit.~ o~ Federal Tax Lien <br />NE sec of S!i!® Jnhn q 6e~c _ <br />Serial Number Fai ~« Fri <br />Lien Unlt Phone. (800) 829-7650 545897409 <br />As provided by section b321, b322, and b323 of the Internal Revenue <br />[ode, we are giving a notice that taxes (including interest and penalties) <br />have been assessed against the fallowing-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 />ame of Taxpayer <br />Z <br />9909597187-e Pss: ~ <br />GRBRERA LOPEZ PEDRO <br />Filed: 05/20/2009 01:50 PM <br />20090394_ <br />Residence 31 ~, N LINCOLN AVE <br />GRAND ISLAND, NE 68801--4776 <br />IMPORTANT RELEASE INI=ORMATION: Far 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 />Tax Period Date of Last Dayy for <br />Kind of Tax Ending Identifying Number Assessment Refiling <br />(a) (b) (c ---(d) (e) <br />104o I ~.~/31/2002I xxx-Xx-o84o 107/11/2005 08/10/20.5 <br />1040 12/31/2003 XXX-XX-0$40 07/28/2008 08/27/2018 <br />Place of Filing <br />X008/008 <br />Unpaid Balance <br />of Assessment <br />8773.28 <br />8167.20 <br />Reg~.ster of Deeds <br />Hall POBOX 1692 Total $ <br />Grand Island, NE 68802-1692 <br />15940.48 <br />This notice was prepared and signed at CHICAGO, IL <br />the o8>~h day of May 2009 <br />on this, <br />....---....----- <br />Signature ~ Title , <br />ACS 12-00-0000 <br />for DEBRA K. HURST (800) 829-7650 <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, 71-465, 1971 - 2 C.6. 409) Form bb8(Y)(t) (Rev. 2-2004 <br />Part t -Kept By Recording OFfice <br />CAT. NO 60025X <br />