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12/10/2009 THU 8:12 FAX 402 471 4429 UCC SECRETARY OF STATE -~yy Hall <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />3 592 -.... -- -- <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien <br />200909579 <br />Area: Serial Number For Optional Use by Recording Qffice <br />SMALL BUSYNESS/SELF EM1?LOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 601508909 <br />NE See of Skrke Jahn A bale - l1CC FTL <br />As provided by section b32 t, 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 United States on all property and rights to pgs : 1 <br />99@9613714-9 <br />property belonging to this taxpayer for the amount of these taxes, and SANTIAGO MARRERO LUIS OMAR <br />12/08/2009 02:18 PM <br />additional penalties, interest, and costs that may accrue. Filed: <br />Name ofi Taxpayer LUIS OMAR SANTIAGO MARRERO <br />Residence 310 W 6TH 5T 3 <br />GRAND 7:SLAND, NE 6$801-4511 <br />IMPORTANT ttEI,EASE INFORMATION: For each assessment listed below, <br />'unless notice of the lien is refiled by the date given in column (e), this notice shall,. <br />on the day following such data, operate as a certificate of release as defined <br />in IRC 8325(a). <br /> Tax Period Date of Last Daayy for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refling of Assessment <br />a (b) (c) (d (e (F) . <br />1040 12/31/2D02 XXX-XX-D588 09/18/2006 7.0/18/201.6 12677.16 <br />7.040 7.2/37./2003 XXX-XX-0588 10/01/20D7 10/31/2D17 13979.38 <br />1040 12/31/20D4 XXX-XX-0588 10/01/2007 10/31/2017 11709.32 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 58802-7.692 <br />Total I$ 38365.86 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 24th day of November 2009 <br />Signature A Title <br />REVENUE OFFICER 24-10-1739 <br />for KAY PONTE (308) 384-850 <br />1007/007 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal lax lien <br />Rev. Rul. 71-466, 1871 - 2 C.e. 409) ~ / ; <br />Part 1 -Kept sy Recording Office Form 6fi8(Y)(c) (Rev. 2-20041 v <br />GAT. Nd 60025X <br />