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o7/z$/zoo9 TuE 15: z6 <br />0 <br />Fanln 668 (Y)(c) <br />(Rev. February 2004) <br />FAX 402 471 4429 UCC SECR8TA1tY OF STATE ~~~ Hall <br />X003/005 <br />Department of the Treasury -internal Revenue Service <br />~_.:.,._. Notice of Federal Tax Lien 2 0 0 9 0 6 2 2 3 _,____~ <br />_ ._._ <br />.. <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED A12FsA #4 <br />Lien Unit Phane: (800) 913; 6050 565764509 <br />As provided by section 6321, 0,322, and 6323 of the internal Revenue <br />Code, we are_ giving a notice that taxes {including interest and penalties) <br />have been assessed against the following-named taxpayer. We have made <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the united States on all property and ruts to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer J G AND J INC , . a Corporation <br />For pption~l Use <br />N! Sac ai mate Jahn q aal• -UCC FSL <br />990860327'8-1 Pe$: ~ <br />J G AND d INC A CORPORATION <br />Filed; ©7128!2009 01:31 PM <br />Residence 2118 N WESB RD <br />GRAND ISLAND, NE 68803-1737 <br />IMPORTANT RELF.ASg INI:ORMATION:1=or 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, operpte as a certificate of release as defined <br />in IRC 6325(a). <br />Tax Period Date of last Dayy for <br />Kind of Tax Ending Identifying Number Assessment R,efiling <br />a b (c d (e) <br />6721 12/31/2005 47-0755101 10/06/2008 7.1/05/2018 <br />941 12/3]./2008 47-0756101 04/13/2009 05/13/2019 <br />place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 58802-1692 <br />Unpaid Balance <br />of Assessment <br />Tatai ~ $ <br />11659.80 <br />571.61 <br />12231.41 <br />This notice was prepared and signed at <br />the 16.th day of July <br />Signature <br />for KAY <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br />an this, <br />.... ~, ~- <br />29;-10-1739 <br />(NOTE: Gertificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rav. Rul. 71-466, 1971 - 2 C.9. 409) Form 668('lf)(c) (Rev. 2-2004 <br />,~,,,. _ :.;,,,,:.~ Part 1 - Kept ~ Recording OFf~ce, ,.,_.._..,.. CAT. N©"60025X <br />""_' _~ .. <br />CHICAGO, IL <br />2009 <br />