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11/12/2009 THU 14:28 FAX 402 471 4429 UCC SECRETARY OF STATE aa~ Ha11 X003/004 <br />b~ 3592 <br />Department of the Treasury -Internal Revenue Se^~~^^ <br />FAr~M ~~Q ~~~r~ Nrt S.~ .t Sa.a. Jah.. W 6.t. - IICC FTL <br />(Rev. February 200x)" Notice of Federal Tax Lie n <br />Area: Serial Number For t <br />SMALI, $U3INE3S/88TJF BMPI,OYED ARIA #4 <br />Lien Urnt Phone; (800) 913-6050 595864009 <br />/1s pro~rided by section b321, b322, and 6323 of the Internal Revenue 9e0eatxs6a-a Paz: 1 <br />A <br />0R <br />COd®, We are <br />giving a notice that taxes (including interest and penalties) 11%R~/2009 09:31 AM <br />F <br />1~ <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 ali property and rights to <br />property belonging to this taxpayer far the amount of these taxes, and 2 0 0 9 0 <br />8 <br />9 9 0 <br />additional penalties, interest, and costs that may accrue. . <br />. <br />Name of Taxpayer FRED FALLDORF <br />Residence •4233 UTAH AVE . <br />GRAND ISLAND, NE 68803-1D02 <br />IMPQR'1iANT 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 Balance <br />Kind uif:Tax ~ndhig Identifying Number Assessment <br />~ Refiling of Assessment <br />` a ~ b c) d e f) <br />.1040 12/3.1/2000 XXX-XX-$973 04/21/200$ 05/21/2018 4332$.52- <br />:1040 12./31/2001 XXX-XX-8973 06/20/2005 D7/20/2015 12611.7.5 <br />Place of Filing <br />Rega.ster of Deeds <br />Hall PQBOX 1692 Total $ 55940.27 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at CHICAGO, IL <br />the.. 03rd ..day of November 2009 <br />on this, <br />Signature - ~ f~ ~/~!P~ Title <br />REVENUE OFFICER 24-10-1737 <br />for MICHAEL W PONTE (308) 3$4-4850 <br />(NQTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />--Rev. RuL 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) IRev. 2-2004) <br />Part t -Kept By Recording Office CAT. NO 60026X <br />