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07/01/2009 {N~b 15:14 FAX 402 471 4429 UCC SECR}3TARY OF STATE ~yy Hall ~~ Form 6i8 (Y)(c) IRev. February 2P04)~;~"; X004/004 Department of the Treasury -Internal Revenue Service 2 Q O (~ 0 5 3 6 4 ;.... Notice of Federal Tax Lien :~;;~;~~.. _ ._~_ ~ F_,_ _ „~~ FTL~ Area: Serial Number ~Or ~ SMALL BUSINESS/S1aLF EMPLOYED AREA #4 Lien Unit Phone: (800) 913-6050 558074709 As provided by section b321, 6322, and b323 of the Internal Revelnue Code, we are giving a Halite that taxes (including interest and penalties) ggp~9B01®413-2 Fs°7 1 have been assessed against the following-named taxpayer. We have made oR~LLaNa caRLas Filed: 07/01/2009 01:05 PM a demand for payment of this liability, bat it remains unpaid. Therefore, there is a lien in favor of the United States on all property and rights to properly belonging to this taxpayer for the amount of these taxes, and additional penalties, interest, and costs that may accrue. Name of Taxpayer CARLOS ORELLANA Residence 3 04 S VINE ST GRAND ISLAND, NE 68801-7819 IMPORTANT RlrLEASE 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 IRC 6325(a). Tax Period Date of Last Dayy far Ltnpaid Balance Kind of Tax finding Identifying Number Assessment Refiling of Auessment (a). (b) c d e 1040 12/31/2004 XXX-XX-6896 04/13/2009 05/13/2019 199.68 1040 12/31/2005 XXX-XX-6896 05/11/2009 Ofi/10/20].9 42.18.26 10'40 12/31/2007 XXX-XX-6896 06/01/2009 07/01/2019 5001.54 Place of Filing Register o:E Deeds Ha1.1 POBOX 1692 Tvtal $ Grand Island, NE 68802-1692 This notice was prepared and signed at CHICAGO, IL the 17th day of June 2009 94.9.48 on this, Signature ~ A ~~ REVENUE OFFICER 24-10-1720 for DANIELLE L MUELLER (402) 473-4675 x2912 I Rev. Rul. 71-46B, 1971 - 2 C.B. 409) Form bb8(Y)(c) IRev, 2-2004) ' . _ ......... Part .t. -Kept By Recordina Offite :. ...... CA7. Nq 60025X ~-~.