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09/01/2009 TUE 14:34 FAX 402 471 4429 ^CC SECRETARY OF STAIR ~~~ Hall <br />5191. <br />U Department of the Treasury -Internal R®venue Service <br />Form 668 (Y)(t) <br />(Rev. February 2004) Notice of Federal Tax Lien <br />Area: Serial Number For Optional Use by Regarding Office <br />SMALL $U3INE3S/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (Soo) 913-6050 <br />574397709 ~ s.e of sa.a^ john w o.u - ucc FTC <br />As provided by section b3Z 1, 6322, and b323 of the Internal Revenue <br />Code, we are gluing a notice that taxes (including interest and penalties) <br />have been assesxed against the Fallowing-named taxpayer. We have made <br />a demand for payment of this liability, but it remains unpaid. Therefore, P®s : 1 <br />gg0g606038-6 <br />there is a lien in favor of the United States on all property and rights t0 J G RND J INC, R CORPORRTION <br />Filed: 09/01/2009 10.34 RM <br />property belonging to this taxpayer for the amount of these taxes, and <br />addltbnal penalties, interest, and casts that may accrue. <br />Name of Taxpayer J G AND J INC, a Corporation <br />Residence 2118 N WEBS RD 2 Q Q 9 Q "7 i Q <br />GRAND ISLAND, NE 68803-1.737 <br />IMPORTANT REI.F.ASE INFORMATIgN: For each assessment listed below,- <br />. unless notice of the lien is refiled by the date given in column Is-, this notice shall, <br />on the day following such date, .operate as a certificate of release as defined <br />in IRC 6325(a-. <br /> Tax Period Date of Last Dar~rr far Unpaid Balance <br />Kind of Tax finding Identifying Number Assessment Ref;ling of Assessment <br />a) (b) t d (e) <br />941 12/31/2005 47-0756101 04/17/2006 05/17/2016 <br />941 12/31/2005 47-0756101 04/15/2009 05/15/2019 7034.48 <br />Place of Filing <br />Register of needs <br />Ha11 P~B~X 1692 <br />Grand Island, NE 68802-1692 <br />Total ~$ 7034.48 <br />This notice was prepared and signed at CHICAGO, IL <br />the 19t:h day of August 2009 <br />X005/005 <br />on this, <br />Signature ~ y ~~ Title <br />REVENUE OFFICER 24-10-1739 <br />for KAY PONTE (308} 384-4850 <br />(NOTE: Certificate of officer authorized by lew to take acknowledgment is n6t essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 6b8(Y)(t) (Rev. 2-2pQ4) <br />Part A -Kept By ItecordinE Office CAT. NO 60025X <br />