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12/15/2009 TUE 14:41 FAX 4p2 471 4429 UCC SECRETARY OF STATL yy-~ Etall <br />_~ Form 668 X t <br />~ )~ ) <br />• (Rev. February 2ooa) <br />i~004/007 <br />592 <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Jaen <br />Area: Serial Number For Optional Use by Recording Office <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 604557009 <br />As provided by section 632 t, b322, and 6323 of the internal Revenue "~ ~°° °f SFete Jphn p Gere - pCL FTL <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 far 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 /> <br />property belonging to this taxpayer for the amount of these taxes, and lasessi4zss-s <br />PEREZ RIVERA ALEXIS Pqs: ~ <br />additional penalties, interest, and costs that may accrue. Filed: 12/15/2009 11:09 qM <br />Name of Taxpayer ALEXIS PEREZ RIVERA <br /> 2oo9oss~~ <br />Residence 904 W 16TH ST <br />GRAND ISLAND, NE 6$$01-3520 <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 following such date, operate as a certificate of release as defined <br />in IRC 63251a). - <br /> Tax Period Date of Last Dayy for Unpaid Balance <br />Kind of Tax Ending identifying Number Assessment Refilin g of Assessment <br />(a) b) (c) (d) (e) (f) <br />1040 12/31/2002 XXX-XX-5617 11/07/2005 12/07/2015 4768.32 <br />Place of Filing <br />Register of Deeds <br />• ~ Hall POBOX 1692 <br />•• Grand Island, NE 68802-1692 <br />Total I$ 476$.32 <br />This notice was prepared and signed at <br />:.° <br />the 04th .day of December 2009 <br />Signature A <br />~ ~~or DANIELLE L MUELLER <br />Title <br />REVENUE OFFICER 24-10-1720 <br />(402) 473-4675 x2912 <br />CIiZCAGO, IL <br />on this, <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. 71-466, 1971 - 2 C.B. 4091 Form 668(Y')(t) (Rev. 2-20041 <br />• fart t - IiCept SY Recording Office CAT. NO 60025X <br />