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<br />1D/27/2009 TUS 15:07 FAX 402 471 4429 UCC SECRETARY OF STATE yyy Hall <br />ia1006/009 <br /> 3682 <br /> Department of the Treasury -Internal Revenue Service <br />Farm bb8 (Y)(c) 2 0 0 9 0 8 5 7 8 <br />Notice of Federal Tax Lien <br />(Rev. February 2004) <br />Area• Serial Number Fr- nnr[anal Use b Recording Office <br />SMALL BUSIIVEB$/$ELF I;MPLpYED AREA ~4 tie spr of S+eie John q <br />`'' <br />Lien Unit Phone: (sac) 913-5050 590998609 <br />ucC Fri <br />e " <br />As provided by section b321, b32Z, and b323 of the internal Revenue <br />Code, we are giving a notice that taxes (including interest and penaltiies) <br />have been assessed against the following-named taxpayer. We have made <br /> <br />a demand for payment of this liability, but it remains unpaid. Therefore, 9909010$79 <br />JpNO~SEK a P <br />0 <br /> <br />there is a Hen in favor of the united States On all property and rigfits to s:: 1 <br />Ft led- 10/ <br />27N/pz0e9 ~ ~ <br />5 <br /> <br />property belonging to this taxpayer for the amount of these taxes, and : <br />4 pp <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer DONALD R JANOUSSK <br />Residence 1524 COVENTRY LN APT 18 <br />GRAND ISLAND, NE 58801-7065 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the Ifen 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(a1. <br /> Tax Period Date of bast Dayy for Unpaid BaWnce <br />Kind of Tax Ending Identifying Number Assessment Refiling of Assessment <br />(a) b c d e) C~ <br />1040 12/31/2000 XXX-XX-D130 12/18/2005 01/17/2017 2974.90 <br />7.040 12/31/2002 XXX-XX-0130 12/18/2006 01/17/2017 939.57 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1592 <br />Grand Island, NE 68802-1592 <br />Total I $ 3 91-4.4 7 <br />This notice was prepared and signed at <br />the 15th day of October <br />CHICAGO, IL <br />~~~~ <br />on this, <br />Signature ~ ~7 ~,~,,,~ ~~ OFFICER 24-10--1720 <br />for DANIELLE L MUELLER (402) 473-4675 x2912 \ / <br />(NOTE: Certificate of officer authorised by law to take acknowledgment is net essential to the validity of Notice of Federal Tax lien V <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) - _' - _• ~~ Farm bb8(Y)(c) (Rev. 2-2004) <br />