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10/27/2009 TUE 15:Ofi FAX 402 471 4429 UCC SECRETARY OF STATE ~M~ Hall <br />~~ <br />CHICAGO, zL <br />3682 <br />Department of the Treasury -Internal Revenue Service <br />Form 668 (Y)(c) Notice of Fedelral Tax Lien X 4 0 9 0 8 5 7 7 <br />tRev. F=ebruary zaoai <br />Area• Serial Number For Optional Use by Recording Office <br />Sl!+IAI,I, BCJSINESS/SELF EMPLCYET~ AREA #4 <br />Lien Unit Phone; (800) 913-6050 589974709 <br />NE Sec vi S1~le Jahn R Osle - VC[ FTL <br />As provided by section 6321, 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 <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the United States on all property and rights to 9909610378-6 Pgs ~ 1 <br />property belonging to this taxpayer for the amount of these taxes, and JAIME JUANItA A <br />Fl led: 10/27/2009 11:54 AM <br />additional penalties, interest, and casts that may accnre. <br />Name of Taxpayer JUANZTA A JAIME <br />Residence 1011 SAINT PAUL RD <br />GRANS ISLAND, NE 68801-3901 <br />IMPORTANT RELEASE INFORMATION: Far each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 8325(a). <br /> Tax Period Date of Last Daayy for unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Re~i[ing of Assessment <br />(a (b) c d) a (f) <br />1040 7,2/31/1,997 XXX-XX-4565 04/11/2005 05/11./20x5 6252.9'7 <br />Place of Filing <br />Register of Deeds <br />Ha11 POBOX 1692 Total $ 6252.97 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />the 14th day of October <br />Signature <br />for DANZ <br />2009 <br />X005/009 <br />an this, <br />ri . / ~ uu <br />L MUELLER <br />Title <br />REVENUE OFFICER <br />(402) 473-4675 x2912 <br />24-10-1720 , / <br />V <br />(NOTE: Certificate pf officer euthoriaed by law to take acknowledgment Is not essential to the validity of Notice of Federal Tax lien <br />Rev, Rul. 71-466, 1971 - 2 G.9. 409i Form bb8(Y)(c) (Rav_ 2-2004) <br />Farr 1 . rlao.e IF:v QarnrAtao' l?rfirw ..... .... ............ <br />