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07/28/2009 TC~E 15:26 <br />Form b68 (Y)(c) <br />(Re>~.,February 2004- <br />FAR 402 471 4429 pCC SECRETARY OF STATE ~~~ Hdll <br />$$ <br />X004/005 <br />Department of the Treasury -Internal Revenue Service 2 0 O 9 O S <br />Notice of Federal Tax Lien <br />. ............... ArBac .. ....... -... ... ... .... .. .......Serial Number For Optional Use <br />SMALL BUSINESS/SELF EMPLOYED AR$A #4 <br />Lien Unit Phone: (800) 913-6050 565$24509 <br />As provided by section 632 i, 6322, 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 rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additions! penalties, interest, and costs that may accrue. <br />Name of Taxpayer DONALD & BARBARA RASMUS3EN <br />N5 See of S1sle John A Gele l1CC FR <br />9909603279-8 Pgs: 1 <br />Filedss07/28/ ®08 01:31 pM <br /> <br />Residence 3606 AVENCTE L <br />KEARNEY, NS 68847-3271 <br />IMPORTANT RgLF.ASE iN~ORMATION: For each assessment listed below, <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 6325(a). <br /> Tax Period Date of Last Daayy for unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Reflling of Assessment <br />a) b (c) d) (e) <br />1040 12/37./2003 XKX-XX-4005 05/1]./2009 06/10/2019 $35.49 <br />1040 12/31/2004 XXX-XX-4005 07/02/2007 0$/01/2017 3180.51 <br />1040 12/31/2005 XXX-XX-4005 08/06/2007 09/05/2017 ~~ 16523.34 <br />1040 12/31/2006 xxx-XX-4005 05/28/2007 06/27/2017 1589.57 <br />Place of Filing <br />Regist=er of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-7.692 <br />Total ~$ 22128,91 <br />This notice was prepared and signed at <br />the 21st day of July <br />CHICAGO, IL <br />2009 <br />an this, <br />Signature ~ f7 <br />for PATRICK J KELLOGG <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br />24-10-1744 <br />~nar. e:: ~ertlnca>:e or orncer autnorizea ny:aw to taK9 acknowledgment is not essential to the validity of Notice of Federal Tax li¢n <br />Rev. Rul. 71»466, 1971 - 2 C.B. 409) Form 668(lf7(c) (Rev. Z-20041 <br />Part 7 -Kept ey Recording ce <br />~., CAT..NQ 60025X <br />.~wM., , .,~ ...... ..,.,.~ .._._.... . r,.-.. <br />i <br />