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07/21/2009 TUE 14:55 FAX 402 471 4429 UCC SECRBTARX OF STATE ~-~~ Hd11 <br />~ $BO1 <br />Department of the Treasury -Internal Revenue Service <br />nor"' BBa nr)(t) Notice of Federai Tau Lien <br />• (Rev. February 2004) <br />~..._.. <br />Area: ~ Serial Number ~ NE Sic of State Jahn A fisl^ - uCL FTL <br />SMALL BIISINTSS/SELF EMPLOYIu~A AREA #4 <br />Lien Unit Phone: (800) $29-3903 563494609 <br />As provided by section 6321, 6322, and 6323 of the internal Revenue <br />Code, we are giving a notice that takes (including interest and penalties) <br />have been assessed against the following-named taxpayer. We have made 9909802623-3 P9s : 1 <br />a demand for payment of this liability, but it remains unpaid. Therefore, rHOMPSON oavio <br />there is a lien In •favor Of the united States on all property and rights to Filed: 07121 /2009 10:46 AM <br />property belonging to thif taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br /> 2 0 0 9 0 5 9 91 <br /> <br />Name of Taxpayer DAVID THOMPSON <br />Residence 511 E 13TH ST <br />GRAND ISLAND, NE 68$01--3876 <br />IMPORTANT RELEASE iNP~RMATi~N: Far each assessment listed belgw, <br />unless notice of the lien is refiled by the date given in column (el, this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 63251a1. <br /> Tax Period Date of bast Dayy for Unpaid Balance <br />Kind of Tax Ending identifying Number Assessment Reflling of Assessment <br />a b (t) d (e) <br />1040 12/31/2002 XXX-XX-0229 10/31/2005 11/30/2015 8509.86 <br />1040 12/31/2003 XXX-XX-0229 08/11/2008 09/10/2018 4555.32 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ 13065.18 <br />Grand Is3land, NE 68802-1692 <br />This notice was prepared and signed at CHICAGO, YL <br />the 08th day of July 2009 <br />f~oo2/003 <br />on this, <br />Signature ~ A 11'y~.~ Title <br />ACS 24-00-0008 <br />for MICHAEL ~1. COX (800) 829-3903 <br />(NOTfs': Certificate of officer authorized by law w take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 77-466, 1971 - 2 C.B. 409) Farm 668(n(c) iRev. 2-2004) <br />Part 1 - Kept ~ ftecordin$ Office CAT. NO B0025X <br />