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07/13/2009 tx01~1 14: S1 1-AX 402 471 4429 OCC SSCRBTARY OP STATS ...~ ball. 8801 Department of tl~e Treasury -Internal Revenue Service dorm 8b8 (Y)(t) ~~,.~lotice , ~ Fedeir~ 'fax Lien IRev. February 20D41''.",•: . -:~••. A e Serial Number For optlar,al Use b Recording office r a: BiKAI,L BUSINESS/SSI,P 1~LO7f7~~ 1#lt>3Pi #e Lien Unit Phone: (8001 913»6050 563D63609 ~ s,r r~ s+w~, aoti~ a 6.:. , ucc FTL As pirovldad by sectia>t b321„ b322, arul b323 of the leternar Rewnete Code, we era 8rvin>f a notke that taxes (hx~udhtp interest and penalties) . 'have been assessed agahfist the fdbwin8-pained taxpayer. We have mwde a de>tnand for pa~rment of the Ii~ilNtj-, but it remains unpaid. Thex'at'ore, theta ix a Iien h~ favor ~ tiw illeited States on aH property and rights to ese9se394fib-a ~:: f ~-rQperty be~ to this taxpayer for the alnollnt ~ th~a rases, and Fl lsd~•. 07~ /13%2 i 1: 2$ pM additiatal penaldes, h>ttere:t, and .wets that rniay aurae. Name of Taxpayer EDWARD PERE SISRRA ~~Q9Q5705 .Residence 412 S 6TH ST GRAND ISLAND, NB 68801-4307 ~ ~ -~ IMPORTAI~1'r':Itlt,LiFASE IhIFORMATiO1i1: For each easessment listed below, unless notice .of the lien is retiled by the date given In column (e!, ibis notice shall, on the day follovfing. such date, operate as a certificate of release ea defined in IRC f33261el. Tax Perbd ~ Data of Last D for ltlnpaid IERaWnice Kind of Tax Ending Identi(ying hlwnber Amt Refl~ • ~ ~ Ass~aertt a (b) t d e 1040 12/.31/2000 XXX-KX-0116 05/28/2D07 06/27/2017 ~ 10079.57 1040 •12/31/2001: XXX,-7~X-0116 05/28/2007 06/27/2017 1.18$4.19 10.40 12/31/2-002 XXX'-XX-0:116 O5/2$/2D07 06/27/2017 4276.75 1040 12/31/2dQ3 XXX-xX-0116 05/28/2007 06/27/2Q17 6599.55 1040 12/31/2Q04 XXX-XX-0116 11./12/2007 12/12/2017 22819.10 Place Of Filing Register of Deeds . Hall POBOX 1692 Total $ Grand Island, NE 6880a-1692 Boos/oo7 55655.1.6 This notice was prepared and signed at CHICAGO' 11' the 07th day of July 2009 an this, ..~x, Signature ~ N ~~~~ Title REVSNUFS OFFICSR 24-1.A--1737 .- for MICHAEL 1iP PONTP (308) 384-4850 ' (IiIOTRt Certificate of officer authorized by iaw to take acknowledgmern is not essential to the validity of Notice of Federal Tax lien Rev. Rul. 71-A~Bf3, 9971 - 2 C.B. 409) Farm 66$(n(c) (Rev. 2-2004} .. - ._ ~....: ~at't 1.-1Gpt ~- Recording O(fice , .~. - CAT. NO 80026X ,.,,•.'.~..