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12/22/2009 TUE 15:37 FAX 4p2 471 4429 UCC SECR8TA12Y OF STATE ~yy Hall <br />~~ 3592 <br />l]epartment of the Treasury -Internal Revenue Service <br />Form db8 (Y)(t) <br />(Rev. February 2004) Notice of Federal Tax Lien <br />Area: Serial Number For Optional Use by Recording Office <br />SMALL BUSINESS/SELF EMPLO~fED AREA #4 <br />Lien Unit Phone: ($p0) 913-6050 606993109 <br />AS provided by section 6321, 6322, and 6323 of the Internal Revenue N~ s.~ °. st,t='°"" F bale - OCC FT4 <br />Code, we are giving a notice that taxes (including interest and penalties) <br />have been assessed against the folbwing-named taxpayer. We have made <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a Bien 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 P9S' ' <br />9809614904-3 <br />additional penalties, interest, and costs that may accrue. EDDY KERRY E <br />12/22!2009 02:33 PM <br /> piled: <br />Name of Taxpayer KERRY E EDDY <br /> 2oo9a <br />oos4 <br /> <br />Residence 1205 CEDAR RIDGE ROAD APT 5B . <br />. <br />GRAND ISLAND,.NE 68$03-8064 <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 natiae shall, <br />on the day fallowing such date, operate as a certificate of release as defined <br />in IFiC fi325ia). <br /> Tax Period Date of Last Day for <br />~ Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refilling of Assessment <br />(a) b) c) d e) (f) <br />1040 12/31/2001 XXX-XX-9155 07/24/2006 08/23/2016 7662.4. <br />1040 12/31/2002 XxX-XX-9155 07/24/2006 08/23/2016 9476.99 <br />1040 12/31/2004 XXX-XX-9155 12/08/2008 01/07/2019 4774.12 <br />Place of Filing <br />Register of Deeds <br />Hall PoBOx 1692 <br />Grand Island, NE 68802-1692 <br />Total ~ $ 21913 .5 2 <br />This notice was prepared and signed at <br />the <br />Signature <br />for DA: <br />11th day of December <br />A 0 <br />JIELLE L MUELLER <br />Title <br />REVENUE OFFICER 24-10-1720 <br />(402) 473-4675 x2912 <br />bolo/olz <br />CHICAGO, IL <br />2009 <br />on this, <br />Rev. Rul. 71-46fi, 1971 - 2 C.B. 409) part 1 -Kept By Recording Office -•- ^- -' - •_ - f -_ -, Form 668(YCAT. N(7v60025X4) '. <br />1. <br />