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10/29/2009 THU 14:31 FAX 402 471 4429 UCC SECRETARY pF STATE ~~~ Hall <br />~002/OD4 <br />form 668 (Y)(c) <br />(Rev. February 20p4) <br />3682 <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien 2 0 0 9 4 8 6 4 <br />Area: Serial Number For Optional Use by Recording Office <br />SMALL SU5INF3SS/SELF EMPLOY® AREA #4 <br />Lien Unit Phone: (800) 913-6050 591221509 NE SYO of Sl.ta .)aNn A G.1• - YCC FTL <br />As provided by section b3,Z 1, 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 (lability, but it remains unpaid. Thereforo, <br />there is a lien in favor of the United States an all property and rights to 8909610753-8 Pss: 1 <br />property belonging t0 this taxpayer for the amount of these taxes, and FQi a":A10i2gi20ps 10:06 AM <br />additional penalties, interest, and casts that may accrue. <br />Name of Taxpayer SCOTT A GALUSHA <br />Residence 1004 N DIERS AVE STE 230 <br />GRAND ISLAND, NE 68803-4962 <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 fallowing such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br /> Tax Period Date of Last Dayy for unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refiling of Assessment <br />a) b) c d (e) <br />6721 12/31/2005 68-OS40S09 12/22/2008 01/21/2019 990.00 <br />940 12/31/2007 68-0540509 12/29/2008 01/28/2019 1333.61 <br />941 12/31/2007 68-D540509 02/16/2009 03/18/2019 2119.05 <br />941 03/31/2008 68-0540509 03/30/2009 04/29/20].9 2072.30 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ 6514.95 <br />Grand Island, NE 6$802-1692 <br />This notice was prepared and signed at <br />the 19th day of October <br />Signature <br />for DANIELLE L M[7ELLER <br />on this, <br />Title <br />REVENUE OFFICER 24-10--1720 <br />(402) 473-4G75 x2912 <br />CHICAGO, IL <br />2009 <br />Rev. Rul. 71-486, 1871 - 2 C.B. 409) Form 6b8(Y)(c) (Rev. 2-2004) ~~ <br />Part t -Kept lay Recording Office CAT, NQ 80025X v <br />