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11/30/2009 MON 14:33 FAX 4p2 471 4429 UCC SECRETARY pF STATE ~~~ Hdll <br />Fnrm 668 (Y)(t) <br />IRev. February 2D04) <br />I~J003/004 <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien 2 0 U 9 U 9 4 5 U <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYEb AREA #4 <br />Lien Unit Phone: (80D) 913-6050 6DD3236D9 <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 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 lJnited States on all property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and vests that may accnre. <br />Name of Taxpayer JUAN J SANTIAGO ALEJANDR <br />For Optional Use by Retarding Office <br />NE SvC of itnkr Jehn W 6sls - IICC F7L <br />9909613052-5 Pgs: 1 <br />SANTIA60 ALEJANDR JURN J <br />Filed: 11/30/7009 09:26 AM <br />Residence 2219 'W CAPITAL AVE <br />GRAND ISLAND, NE 68803 -2002 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below <br />, <br />;._unless_notic of,t~~i,~~(. 'fe Y #,~,~ 1~~.!!~!>~Y,U?.,~,, ~i~,f1.P~,E <br />, <br />~ ~~„ ., <br />, <br />~ <br />. <br />,, <br />,. <br />. <br />~.~:~:... <br />, <br />, <br />. <br />~ <br />, <br />on the day following such data, operate as a certificate of release as defined „~, <br />..~ <br />.~,~, <br />.._-:~-..~s,~...a.~~~-..~,,.K-~, <br />in IRC 6325(a). <br />Tax Period <br />Kind of Tax Ending Identifying Number Date of <br />Assessment Last Day for <br />Re -ling unpaid Balance <br />of Assessment <br />(a) (b) (~ (d a (f <br />1040_ 12/3]./2000 XXX-XX~9854 06/04/2007 07/04/2017 5483.28 <br />1040 12/31/2001 XXX-XX-9854 06/04/2007 07/04/2017 8016.53 <br />1040 12/31/2002 XXX-XX-9854 06/04/2007 07/04/2017 21772.10 <br />1040 12/31/2003 XXX--XX-9854 06/04/2007 07/04/201.7 30271.25 <br />1040 12/31/2004 XXX-XX-9854 06/04/2007 07/04/2p17 33405.22 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total ~$ 98948.38 <br />This notice was prepared and signed at <br />CHICAGO, TL <br />the 19th day of November 2009 <br />Signature ~ A <br />for KAY <br />Title <br />REVENUE OFFICER <br />(308} 394-4850 <br />24-10-1739 <br />on this, <br />(1Ni0YE; Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 79-486, 1971 - 2 C.B. 409) <br />Part 1 -Kept 13y Recording Office Form bb8(lt~(c) (Rev. 2-20041 <br />reT yin ann~r;v <br />