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11/30/2009 MON 14:33 PAR 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br />Form bb8 (Y)(e) <br />(Rev. February 2004) <br />I~f004/004 <br />'3682 <br />SMALL BUSINESS/SELF EMPLOXED AREA #4 <br />Lien Unit Phone: (800) 913-6050 600813409 <br />As provided by section b321, b322, and 4323 of the Internal Revenue <br />Code, we are giving a notice that taxes (including interest and penaltiex) <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 property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer BETHANY ROZENDAL <br />pepartment of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Number For Optional Use by Recording Office <br />Residence 115 W CHARLES ST <br />GRAND ISLAND, NE 68801-6.020 <br />N6 See of 51a~e Jelin R 6.1^ - VC[ FTL <br />9909613053-7 pa$: 1 <br />ROZENbpL BETWANY <br />Filed: 11/30/2009 09:28 FlM <br />w0U9Uy451 <br />IMPORTANT RirLEA,Sir INFORMATIQN: For each assessment listed below,. <br />__urfle,~~nati~~ of th~Ji@C1.~irafilad.b~tkie.s(a,ive~in_~nlulnn.:(e~,~.t i r,~~,i~~}~b~~~; - <br />" ~ on tTie 'day fo"~fowng-such date, operate as a certificate of release as defined ~--F~~~~~~~m~~~ <br />in IRC 6325(a). <br />Tax Period Date of Last Dayy for <br />Kind of Tax Ending Idenitifying Number Assessment Refiling <br />(a) (b) (c (d) e) <br />944 12/31/2007 20-3998975 05/05/2008 06/04/2018 <br />Unpaid Balance <br />of Assessment <br />717.60 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total I $ 717.6 0 i <br />This notice was prepared and signed at <br />the 20th day of November <br />2009 <br />CHICAGO, TL <br />on this, <br />Signature ~ ~ ~~ Title <br />REVETiITE OFFICER 24-10-1720 <br />for DANIELLE L MUELLER (402) 473-~4Ca75 x2912 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 79.468, 1971 - 2 C.B.~409) <br />Form bb8(n(c) (Rev. 2-2004) <br />Part 1 -Kept BY Recording Office „~ r ~,,, ,,,,,,,,,... <br />