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12/15/2009 TUE 14:41 FAX 402 471 4429 UCC SECRETARX OF STATE ~yy Hall <br />~.. <br />~• ~ 3592 <br />Department of the Treasury -Internal Revenue Service <br />Form bb8 (Y)(c) <br />. ~' (Rev. February 2004) Notice of Federal Tax Lien <br />Area; Serial Number Far Options <br />SMALI, BC7SINES$/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 604SS6809 <br />As provided by section b321, b322, and b323 of the Internal Revenue <br />Code, we are girring 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, bat 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 JESUS J FLORES <br />Residence 147.5 W LOUTSE ST <br />GRAND ISLAND, NE 68801-6430 <br />Tax Perrod Date of Last- Dayy for <br />Kind of Tax Ending Identifying Number Assessment Refiling <br />(a (b) (c (d) (e <br />1040 12/31./2004 XXX-XX-6$81 10/02/2006 11/01/2016 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column 1e1, this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 63251a). <br />20090984 <br />unpaid Balance <br />of Assessment • <br />1525.98 <br />Place ofi Filing <br />. Register of Deeds • <br />Hall FOBOX 1692 Total $ 1525.98 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />.the ~ 04th day of December 20D9 <br />Signature <br />for DAN <br />A. I ~t <br />L MUELLER <br />Title <br />REVENUE OFFICER 24-10-1720 <br />(402) 473-4675 x2912 <br />~na,rl t: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of lJotlce of Federal Tax )ien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) <br />Part 1 -Kept By Recording Office Form bbiB(Y)(c) (Rev. 2-2004) <br />CAT. NO 6002fiX <br />ia1006/007 <br />Use by Recordinn Office <br />NE See of Skeke Jnhn A Gale - IICC FY4 <br />9909614268-3 Pas: 1 <br />FLORES JESUS J <br />Filed: 12/16/2009 t1:09 AM <br />