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lQ/27/2009 TUB 15:07 1~AX 402 471 4x29 UCC SECRETARY OF STATE ~~y Hall iaJ007/009 <br />3682 <br />Farm 668 (Y)(c) Department of the Treasury -Internal Re: enue Service ~ o 0 9 o s 5 7 9 <br />lR®~. ~a~r~arv xooal Nonce of Federal Tax Jaen <br />Area' Serl81 111umbef For Optional Use by Recording Office <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 ~ 590399209 Nr: see et 4lelo John A 6~Is - l1CC 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 fallowing-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 990961®580-1 Pss: t <br />property belonging t0 thus taxpayer far the amount Of these taxes, and F~ledOSHOP~~~2009 11 :54 RM <br />-additional penalties, interest, and vests that may accrue. <br />Name of Taxpayer PAT MCINTOSH <br />Residence 606 FAIDLEY CT APT S2 <br />GRAND ISLAND, NE 68803 <br />IMPORTANT RELEASE INFORMATION: For 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 6325(a). ' <br /> Tax Period Date of -Last Dayy for Unpaid Balalnce <br />Kind of Tax Ending Identifying Number Assessment Reflfing of Assessment <br />a b) (c d e) f) <br />1040 12/37./2001. XXX-XX-6$87 02/07/2005 03/D9/2015 141.61.47 <br />1040 12/31/2002 XXX-XX-6887 04/04/2005 05/04/2015 20262.60 <br />1040 12/31/2003 XXX-XX-6887 05/12/2008 06/11/2018 19495.92 <br />1040 12/31/2004 XXX-XX-6887 06/08/2009 07/08/2019 28763.04 <br />1040 12/31/2005 XXX-XX-6887 06/08/2009 07/08/2019 21115.58 <br />1040 12/31/2006 XXX-XX-6887 06/08/2009 07/08/201.9 20296.52 <br />Place of Filing <br />Register of Deeds <br />Ha11 POBOX 1692 Total $ 124095.13 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />the 15th day of October <br />Signature A 0 <br />Title <br />REVENUE OFFICER <br />(3D$) 3$4-4850 <br />CHICAGO, IL <br />2009. <br />on this, <br />24-10-1744 ~ / r <br />V <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validi[y of Notice of Federal Tax lien <br />Rev. Rul. 71-486, 1871 - Z C.B. 409) Form 6G8(lf)(t) (Rev. 2-2004) , <br />Part 1 -Kept E7I Recording OFFice rn7 nir, ~nrn~Y <br />