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09/29/2009 TUE 15:04 FAX 402 471 4429 UCC SECRETARY OF STATE yyy Hall fC - ~j003/005 O~ 3682 Department of the Treasury -Internal Revenue Service Form bb8 (Y)(c) Notice Of Federal Tax Lien iRev, February 2004) Area: Serial Number Fl NE Ssc of Stale John R eal9 - UC[ FTl SMALL BUSINESS/SELF EMPLQYED AREA #4 Lien Unit Phone: {800) 913-6050 5$2293709 As provided by section b3x1, b322, and b323 of the Internal Revenue Cade, we are giving a notice that taxes (including interest and penalties) have been assessed against the following-named taxpayer. We have made ssesfs0a2ay-i Pes: 1 a demand For payment Of this liability, but it remains unpaid. Therefore, Filed:"09K29/2009 09:59 RM there is a lien in favor of the United States on all property and rights w property belonging to this taxpayer for the amount of these taxes, and ~ , additional penalties, interest, and costs that may accrue. Name of Taxpayer NICK P JONES Residence - ----------=-~._ ~ ~.~ = ~-.-:::::~~:=.~-W -~. ---- -=-----~~_-::-~~.~.-:~.-..:::~:.:.~ 903 S VINE ST :....._.:~ .:.:.:..............~.-._...._.__._.---------_-:_~- -::-_ _.- _......__ GRAND ISLAND, NE 68801W8035 IMPORTANT RELEASE IN~ORMATION.~For each assessment. listed below, unless notice of the lien is refiled by the date given in column (e), this notice shall, on the day fallowing such date, operate as a certificate of release as defined in IRC 6325(a). ' Tax Period Date of Last Day for Unpaid Balance Kind of Tax Ending Identifying Number ~ Assessment Refilling of Assessment (a) (b) c d e 1040 12/31/2001 XXX-XX-8266 07/24/2006 08/23/2016 6'844.50 1040 12/31/2002 XXX-XX-8266 09:/04/2005 05/04/2015 6274.95 Place of Filing Register of Deeds Hall POBOX 1692 Total $ 13119.45 Grand Island, NE 68802-1692 This notice was prepared and signed at CHICAGO, IL , on this, the 16th day of September 2009 Signature ~ REVENUE OFFICER 24 -10 -173 9 for KAY PONTE (308) 384-4850 (NOTE: Certificate of officer authorized by law to take acknowledgment is net essential to the validity of Notice of Federal lax lien Rav. Rul. 71-466, 1971 - 2 C.B. 4091 Form 66FJ(Y)(c) (Rev, 2-2004) /// Part 1 -Kept 8y Recording Office GAT. NO 60025X