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12/15/20D9 TUE 14:42 FAX 402 471 4429 UCC SECRETARY OF STATE a~~ Hd11 <br />3592 <br />O Department of the Treasury -Internal Revenue Service <br />Form d68 (Y)(c) ~ , <br />(Rev. February 2004) Notice of Federal Tax Lien <br />Area: Seria) Number For Optional Uae by Recording Office <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone; (Boo) 913-fi050 605307.209 NE Sec a1 S~~kY Jahn q G~1r .. uCC FTL <br />As provided by section 4321, 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 8909614269-5 pGs; 1 <br /> <br />property belonging to this taxpayer for the amount of these taxes, and SLOGGETT JAMES <br />Flled; 12/15/2009 11:09 Art <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer JAMES SLOGGETT <br /> 200909843 <br />Residence 229 WILLOW ST <br />GRAND ISLAND, NE 68$01--1321 <br />IMPORTANT RELi:.ASE 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 ds a certificate of release as defined <br />in IRC 6325(a). <br /> Tax Period Date of Last Dayy for Unpaid Balance <br />Kind of Tax Ending identifying Number Assessment ~ Refiling of Assessment <br />a (b (c) d (e) (f) <br />941 03/31/2008 20-5350069 06/09/2008 07/09/2018 461.74 <br />941 06/30/2008 20-5350069 06/15/2009 07/15/2019 7375.73 <br />941 12/31/2008 20-5350069 04/06/2009 05/06/201.9 421.35 <br />941 06/30/2009 20-5350069 09/14/2009 10/14/2019 258.19 <br />Place of Filing <br />Rega,ster of Deeds <br />Ha11 POBOX 1692 Total $ 8517 , O1 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />the 08th day of December 2009 <br />f~oo7/oa7 <br />on this, <br />Signature ~ H <br />for DANIELLE L MUELLER <br />Title <br />REVENUE OFFICER 24-10-1720 <br />(402} 473--4675 x2912 <br />CHICAGO, IL <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form bd8(lr)(t) (Rev. 2-2004) <br />Part 1 -Kept By Wtcarding office CAT. NO 60025X <br />i <br />`• I <br />