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09/04/2009 FRT 15:14 FAX 402 471 4429 UCC SECRETARY QF STATE ~-~~ Hall ~002/p02 ('~ 5191 V ~ Department of the Treasury -Internal Revenue Service Form 668 (Y)(c) ~ o o s o~ 3 i 2 (Rev. February 2004) Notice of Federal TaX Lien Area: Serial Number For Optional Use by Recording Office SMALL BUSINESS/SEEP EMPT,OXED AREA #4 lien Unit Phone: (S00) 829-3903 ~ ne s.o vE st.t. John w aue - uet FtL 577267409 As provided by section 6321, 6322, and 6323 of the Internal Revenue Code, we are giving a notice that taxes (including interest and penalties) have been assessed against the following-named taxpayer. We have made a demand for payment of this liability, but it remains unpaid. Therefore, ss®seaeazs-5 pga; t there is a Ilan in favor Of the United States on all property and rights to FiladJA09N04/2009 01:37 PM praperty belonging to this taxpayer far the amount of these taxes, and additional penahies, interest, and costs that may accrue. Name of Taxpayer JASON J LISS Residence 218 N DARR AVE GRAND ISLAND, NE 68803-4738 IMPORTANT Rg1,F.ASE INFORMATIQN: For each assessment listed helow, unless notice of the lien is refiled by the date given in column (e), this notice shall, on the day following such date, operate as a certificate of release as defined in IRO 8325(a). Kind of Tax Tax period finding Identifying lilumber Date of Assessment Last Dayy for Rel;ling Unpaid Balance of Assessment a) b) (c) ~ d e (f) 1040 12/31/2002 XXX-XX-3].17 08/04/2008 09/Q3/2018 7267.42 Place of Filing Register of Deeds Hall ~OBOX 1692 Total $ 7267.42 Grand Island, NE 68802-1692 This notice was prepared and signed at the 28th day of August CHICAGO, IL 2009 on this, Signature ~ A ~~ Title '• Acs 24-0o-ooos for MICHAEL W. COX (800) 829-3903 (HpT!£: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien Rev. Rul. 71-466, 1971 - 2 C.B. 409) O(' Part 1 -Kept lay Recording Dfflce Form b68 Y c (Rev. 2.2004) CAT. NO 60025X