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10/27/2009 TUE 15:07 FAX 402 471 4429 [1CC SECRETARY OF STATE ~~~ Ha17. <br />Farm bb8 (Y)(c) <br />(Rev. February 20041 <br />iaJ009/0"09 <br />3682 <br />Department of the Treasury -Internal Revenue Service 2 0 0 9 o s 5 g i <br />Notice of Federal Tax Lien <br />Area: ~ Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 590399409 <br />As provided by section 63x1, ~i322, and 4323 of the linternal Revenue <br />Dade, 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 .properly and rights to <br />property belonging to this taxpayer far the amount of these taxes, and <br />additional penalties, interest, and casts that may accrue. <br />1MpORTANT RELEASE INFORMATION:-For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this notice shah, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 63251a). <br />Residence 232 S PLUM <br />GRAND ISLAND, NE 68801 <br />For optional Use by Recording orrice <br />NE Saq of 54a4s Jahn R Gela pCC FTL <br />9909610582-5 pgs. 1 <br />Fi1gdE 100 27%2009811:54 RM <br />I Tax period I I Date of I Last Da~yy for <br />Kind of Tax Ending Identifying Number Assessment Refiling <br />of Taxpayer CHRISTINE R <br />1040 12/31./2004 XXX-XX-3169 08/18/2008 09/17/2018 <br />7.040 12/31/2005 XXX-XX-3169 08/18/2008 09/17/2018 <br />1040 ].2/37./2006 XXX-XX-3169 05/11/2009 06/7.0/2019 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1592 <br />Total I$ 22394.03 <br />This notic® was prepared and signed at <br />the 15th day of OCt©ber <br />CHICAGO, IL <br />2009 <br />on this, <br />Signature ~,~ <br />A ~ REV <br /> , ENUE OFFICER 24 -1 D--1744 <br />for PATRICK J KELLOGG X308) 384-4850 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential tv the validity of Notice of Federal lax lien <br />Rev. Rul. 71-468, 1971 - 2 C.B. x091 Form b66(X)(c) lRev. 2-2004) <br />413$.42 <br />9998.11 <br />8257.50 <br />unpaid Balance <br />of Assessment <br />