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Form ~ ~ ~ rioparffimen! of ~th~a Treasury- tnternat IRevana~a ~6orvice <br />[w~v.s~+nar~mbersa~8), ~~'~a~~~e_of~~.,~~~erel i"~x L€e~ Under l~t~r~a9 Ue~erae ~.eu <br />Place of Fiiipg <br />Itegittter Qf L'aeds <br />Hall. County Total ~ 3 2,1b8.27 <br />~rt~zd Ialatut, Rebraska 68801 ! <br />t <br />Ties rloticaa was prepared and signed at -Grand TsZand t ~ietsraai~a <br />the 2?th day of Sentember,l9 `?9 <br />. cin this, <br />District -~ <br />Seria(Number F <br />-~o. oct~oner uaa Dv Ae~o,d;~~ o}e~te <br />OMAHA 47 35784 ~ 74 ~~ <br />As provided by sections 8321; 8322, and 6323 of the Intemai Revenue Code, <br />notice is given thaf-taxes (including interest and penalties) have been assessed <br />against the following-named taxpayer. Demand for payment of this liability has <br />been made, but it remains unpaid. Therefore, there is a lien in favar of the United <br />States on all property and rights to property belonging to this taxpayer for the i <br />amount of these taxes, and additional penalties, interest, and costs that may <br />aCCrt}e. <br />Name of Taxpayer <br />Yenneth E. and Ph~rllis A. Clark <br />Residence <br />Zb04 Rosemont ` <br />Grand Island, Nebraska 68801 <br /> Unpaid geianco <br />Kind of Tax ! Tax Period Ended Date of Assessment Identifying Number of Assessment <br />- fN [D7 ~ (e) id) fe) <br />lOt~O - 30 7b12 4-02 79 IMF' Sob-4o-2370 370.66 <br />1040 - 30 7712 4-02-79 . IMF 306-40-2370 1,105.73 <br />1040 .- 30 <br /> <br /> <br />f 7812 4-15-79, 7-30-79 <br />I <br /> <br /> <br />{ <br />f IMF So6~o-2370 <br /> <br />i <br /> <br /> <br />i 691.88 <br />Signature ~~ '~ ~ Title r <br />H cfdi113.ams, Jr, ` Revenue Officer <br />tMUts: CerffNaate of glfitsr authnnzed Dp taw lD take sckrtowiedpmenia la not faaent4l to fM vaNdrry d NW~e of <br />FaWNrt lax Lien G. C.M.?N19. lybPt, C. B. 123.) <br />Part 1 ~• To tte kept tty retwrding ottke : Form 868 (Rev. 9-7$) <br /> <br />