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06/22/2009 MOIL 14:31 FAR 402 471 4429 UCC SECRETA1tY OF STATE y-~-~ Hall <br />8801 <br />Department of the Treasury -Internal Revenue Service <br />Form bb8 (Y)(c) <br />iaeY. Febl~,ary 2ooa, -_- Notice of Federal Tax Lien <br />...~ <br />Area: Serial Number For Qptiona <br />SMALI, BUSxNESS/SELF EMPI.IOYED AREA #4 <br />Lien Unlt Phone: (800) 829-3903 556494809 <br />As provided by section b321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that fasces (ilnciuding innterest and penalties) <br />have been assessed against the folMwing-named taxpayer. We have made <br />a demand for payment of this liability, bat it remains unpaid. Therefore, <br />there is a lien in favor of the united States on all property and rights to <br />property belonging tv this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer A SANTANA <br />......-- <br />Residence PO BOX 112 <br />WOOD RIVER, NE 68883-011,2 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice. of the lien is refiled by the date given in column le), 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 En Bing Identifyi c$ Number Assessment Refiling <br />1040 12/31/2003 XXX-XX--9369 07/08/2008 08/07/201,8 <br />Place of Piling <br />Register of Deeds <br />Hall POBOX 1692 Total $ <br />Grand Island, NE 58802-1692 <br />200905015 <br />Unpaid iSalante <br />of Assessment <br />1o23s.o7 <br />10235.D7 <br />This notice was prepared and signed at CHICAC30, IL <br />the 12th day of '7~e 2009 <br />, an thl5, <br />Signature ` <br />for MICHAEL W. COX <br />ACS <br />(800) 829--3903 <br />24-00-0008 <br />`_,._ _ _............-,.............,. v...,,.,,,~¢,, „y ,o-„ w lgRtl i7{:RnvwlGp~meni I$ npi eSS@nU81 LO Lne V811(11Ty OT NQLICe OT teaeral 18X ilen <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(1O(c) (Rev. 2-2004) ~ / <br />Part 1 -Kept By Recording O(nca CA7. NO 60025X ~/ <br />X003/003 <br />Uss by Recording Office <br />NE feF aT 5~ale Jahn R Gala -UCC FTL <br />9909000142-1 Pss: f <br />sarirawa a <br />Filsd: 08/22/2009 10:33 Ai'1 <br />