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05/21/2009 THU 16:04 BAX 402 471 4429 UCC SECRETARY OF STATE ~-+~ Hall X002/002 8801 Department of the Treasury -Internal Revenue Sarvic® Form 668 (Y)(c) {Rev.,F~~1LNary 20041 Notre of Federal Tax Lien,,.._~ Area• Serial Number F ae se e e. se -~ - Ja hn A 0 .(a - IICC FT4 SMALL HUSZNESS/SNLF BMPLOYBD ARP;A #4 Lien Unit Phone: (Soo) 829-3903 547025709 As provided by section b321, b322, and 6323 of the internal Revenue Code, we are giving a notice that taxes (including interest and penalties) have been assessed against the following-named taxpayer. We have made sses5a7aza-t a~~: 1 a demand for payment of this liability, bolt it remains unpaid. Therefore, Fl~led:~ 50/N21l20W9 11:08 RM there is a lien in favor of the United States on all property and rights to ~, property belonging to this taxpayer for the amount of these taxes, and additional penalties, interest, and costs that may accrue. 2 Q ~ 9 ~~ 9 g s Name of Taxpayer JASON UMMEL Residence 2431 N OUSTER AVE GRAND ISLAND, NE 68803-2034 IMPORTANT RELEASE INFORMATION: For each assessment listed below, unless notice of the lien is refiled by the date given in column (e-, this notice shall, on the day following such date, operate as a certificate of release as defined in IRO 63251a}. Tax Period Date of fast Dayy for Unpaid Balance Kind of Tax Ending Identifying Number Assessment Refiling of Asseument a) b Lc) ~d) e ~ 1040 12/31/2002 XXX-XX-8242 06/06/2005 07/06/2015 449.63 1040 12/31/2004 XXX-XX-8242 02/13/2006 03/14/2016 8223.09 Place of Piling Register of Deeds Ha11 POBOX 1692 Grand Island, NE 68802--1692 Total ~$ 8672.72 This notice was prepared and signed at the 12th day of May Signature ~ ! vu for MICHAEL W. COX ACS (800) 829-3903 24-00-0008 CHICAGO, IL 2009 on this, (NQTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien Rev. Rul. 71.466, 1971 - 2 C.B. 409) Form 668(Y)(e) (Rev. 2-2004) ~ J Part t -Kept By Recording Office CAT. NO fi0025X ~/