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12/22/2009 T[]E 15:36 FAX 402 471 4429 UCC SECRETARY OF STATE yy» Hall <br />V~ <br />X009/012 <br />2 <br />Department of the Treasury -Internal Revenue Service <br />Form 668 (Y)(c) <br />(Rev. February 2004) Notice of Fedora! Tax Lien <br />Area: Serial Number <br />3MAT~T. BIISINESS/SEY,F EMPT,OYED AREA, #4 <br />Lien Unit Phone: (800) 91.3-6050 606992909 <br />As provided by section b321, 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 <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 MICHELLE ANN GRINNELL <br />Residence 12Q8 yJp,RR~ LN <br />GRAND ISLAND, NE 68801-3869 <br />359.88 <br />360.11 <br />IMPQRTANT REREASE 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 />an the day following such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />Tax Period Date of Last Dayy for <br />Kind of Tax Ending Identifying Number Assessment Refiling <br />(a (b c) (d) (e) <br />941 12/31/2003 47-0$42029 05/05/2008 06/04/2018 <br />941 12/3.1/2003 47-0842029 09/08/2008 10/08/2018 <br />944 12/31/2005 47-0842029 05/05/2008 06/04/2018 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802w1592 <br />For Ootianal Use by Recording Qifige - <br />-.. N! sac of Slate John R bale - 0CC hTL <br />99091at4903~t Pgs: t <br />GRINNELL MICHELLE pNN <br />F=led: 12!2212009 02:33 PM <br />2oo9ioos3 <br />Total ~ $ 719.9 9 <br />This notice was prepared and signed at <br />the 11th day of December <br />CHICAGO, TL <br />2009 <br />on this, <br />Signature ~ A ~Ytiia~ Title <br />REVENUE OFFICER 24-10-1.720 <br />for DANIELLE L MUELLER (402) 473-4575 x2912 <br />(NO?E: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Fedora( Tax lien <br />Rev_ Rul. 71-466, 7971 - 2 C.B. 409) <br />Part 1 -Kept $y Recording Office Form 668(Y')(c) (Rev. 2-2004) <br />CAT. NO 60025X <br />Unpaid ,Balance <br />of Assessment <br />