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0$/24/2009 MON 13:$6 FAX 402 471 4429 UCC SECRETARX OF STATT ~~~ Hdll <br />5191 <br />Department of the Treasury -Internal Revenue <br />Form bbl3 (Y)(t) <br />Service <br />,Rev. February zaaa, Notice Of Federal Tax Lien <br />Area: Serial Number For Optional Use by Recording Office <br />SMALL BUSINESS/SELF EMPLOYE]] AREA #4 <br />Lien Unit Phone: (8001 913-fi050 572543809 <br /> NQ Sac M 54 <br /> <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue e4a Jehn q Balr - 11CC FTL <br />Code, we are gnring a notice that takes (including inlterest and penalties) <br />have been assessed against the following-named taxpayer. We have made <br />a detmand for payment of this liability, but it remains unpaid. Therefore, <br />there Ls a lien in favor of the United States on all property and rights to <br /> <br />property belonging to this taxpayer for the amount of these taxes, and sse9aesa7s-t <br />oraz oAaHAn1iE r1 egg ~ 1 <br /> <br />additional penalties, interest, and costs that may accrue. Filed: 08!24!2009 11:51 APr <br />Name of Taxpayer DAPHANIE M DIAZ <br /> ' <br /> 2 0 0 9 U 7 0 <br />O 1 <br />Residence <br />1204 SYLVAN ST <br />GRAND ISLAND, NE 68801-7157 <br />IMPORTANT RELEASE INFORMATION: 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 Dayy for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refili ng of Assessment <br />(a) (b) c (d (e) (~ <br />1040 12/31/2001 XXX-XX-2559 12/05/2005 01/04/2016 4908.24 <br />Place of Filing <br />Register of Deeds <br />Hall POSOX 1692 Total $ 4908.24 <br />Grand Ysland, NE 68802-1692 <br />This notice was prepared and signed at <br />the 12th day of August <br />Signature A <br />for DANIELLE L MUELLER <br />Title <br />REVENUE OFFICER 24-10-1720 <br />(402) 473-4675 x2912 <br />(NOTE: Certificate of officer authorized by taw to take acknowledgment Is not essential to the validity of Notice of Federal Tax Iten <br />Rev. Rut. 71-468, 1971 - 2 C,B. 409) Form bb8(1n(e) (Rev. 2-2004- ~. <br />Part 1 -Kept EY Recording Office CA7. NQ 60025X <br />CHICAGO, IL <br />2009 <br />on this, <br />X005/005 <br />