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lp/a2/2009 F'RI 15: a2 P'A,X 402 471 4429 UCC SECRETARY OF STATF3 ~~~ Hall <br />~ooz/aaz <br />5197. <br />D®partment of the Treasury -Internal Revenue 5ervlce <br />Farm 668 (Y)(c) N4tite Of Fedel"aI Tax Lien <br />(Rev. February 2004) <br /> <br />Area: <br />Serial Numher NE See of Stwle John A 6r1^ .• nsR...n <br />„« F,~ - <br />SIKALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 584892309 <br />As provided by section 632 t, 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 990960863E-a <br /> <br />a demand for payment of thix liability, but it remains unpaid. Therefore, pgs : , <br />Filed 0N02 <br />~ <br />~ <br /> <br />there is a lien in favor of the United States on all property and rights to / <br />x <br />g 12: ®2 pry <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and casts that may accrue. <br />Name of Taxpayer DONALD A NELSEN <br /> 200 <br /> 90797 <br />Residence p0 BOX 993 <br />GRAND ISLAND, NE 68802-0993 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (a-, 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 Day for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Ref illing of Assessment <br />(a) b) (c) (d) (e) (f <br />7.040 12/31/2002 XXX-XX-8740 05/08/2006 06/07/207.6 93649.91 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total ~$ 93649.91 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 24th day of Septembea: 2009 <br />Signature A REVENUE OFFxCER 24-10-1737 <br />for MICHAEL W PONTE (308) 384-4850 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-A6f3, 1971 - 2 C.B. 409) Form 668(n(c) (Rev. 2-2004) <br />Part f -Kept ey Recording Office CAT. NO 60025X <br />