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12/15/2009 T[]E 14:41 FAX 402 471 4429 UCC SECRETARY OF STATE ~-~-~ [adll <br />Farm db8 (Y)(c) <br />IRev. February 2004) <br />ia1005/007 <br />5y~ <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Number For Optional use <br />SMALL Bi1STNESS/SELF $MPLOXED AR}SA #4 <br />' ~~ Lien Unit Phone: (800) 913-605D <br />604556909 <br />As provided by section 6321, 6322, and 6323 of the internal Revenue <br />Code, we are giving a notice that taxes (including interest and penalties) <br />~~ . have been assessed against the following-named taxpayer. We have made <br />. ~ a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the United States on ail property and rights to <br />. ~" property belonging to this taxpayer for the amount of these taxes, and <br />additional penaltiex, interest, and vests that may accrue. <br />-. Name of Taxpayer MICHAEL D JOHNSON <br />Office <br />NC Sec or S4e4a John A dale -UCC FTL <br />9909814287-1 Pss: i <br />JOHNSON MICHREL D <br />Filed: 12/15/2009 11:09 AM <br />2ooso9s4~ <br />Residence 519 W 13TH ST <br />GRAND ISLAND, NE 68801-3623 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate ~s a certificate of release as defined <br />in IRC 6325(x). <br />Tax Period Date of last Dayy for <br />Kind of Tax Ending Identifying Number .Assessment Refiling <br />a (b c) (d) (e) <br />1040 17.2/31/2001+ XXX-XX-0194 07/37./2006 .0$/30/2016 <br />1,470.63 <br />F~lace of Filing. <br />Register of Deeds <br />.. Ha11 1?OBOX 1692 Total $ <br />Grand Island, NE 68802-1692 <br />1470,63 <br />This notice was prepared and signed at CHICAGO, IL <br />the 04tY1 day of December 2009 <br />. -. - <br />.. <br />Signature <br />for DANI <br />• ~.~~. <br />A. <br />L MUELLER <br />on this, <br />Title <br />REVENUE OFFICER 24-10-1720 <br />(402) 473-4575 x2912 <br />Unpaid Balance <br />of Assessment <br />(nvTE; Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-468, 1971 - 2 C.B. 409) <br />Part 1 -Kept By Ikecording Office Form 668(lU(c) IRev. 2-2004-„ <br />CAT. NQ 60025X { \~~1 ' <br />