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r <br />;'_ This notice warm pre~lared and_si~ at __CrrAx),d Island, Nebraska <br />~n this.- - <br />the 21st day of Deoember ,19 79 <br />Signature p - Title T <br />Lyle D. Metzge / ~^ Revenue Offioer <br />t)Yota: CertlHesle of oHicor autAwizetl by law !o take acknowlsdpments +a not easentrrl to tba vaNi{liry of MWica d <br />Pta~ral Tax Lian Q.C.M. 26s1G, 1854 t, C.B. 128.) <br />Part t - To be kept by recording ottiCe Form 868 (Rev. 8.78) <br /> <br />form '~~ ~ DeGt'srtment at rttte'rr~asury.- 4rtrirnxl iFiES~ioenuea ~Sein.~ica <br />{Rev. Septemhort~g7811' ItI~I~B' Qf i=edera~~~:i Tax Lien ~1~~.nde~~ i~te~nai Rer~e~ue La.w~s <br />- .~~ ~; Serial .~.~.___..____,-__.-~- --- -- <br />Distn ~rc~'' -~ <br />Number ~ Fw Options! Use by Aecortlirtg Oflica <br />1 <br />~~ 47 , 36166 R8E i <br />_~: <br />As provided by sections 6321, 8322, and 6323 of the"Internal Revenue Code, ~ ~9 <br />notice is given that taxes (ine(uding interest and penalties} have been assessed j <br />against the following-named taxpayer. Demand for payment of this (lability has <br />been made, but it remains unpaid. Therefore, there is a lien in favor of the United <br />States on all property and rights to property belonging to this taxpayer for the <br />amount of these taxes, and additional penalties, interest, and costs that may <br />accrue. I <br />Name of Taxpayer - <br />Jan A.ojewski j <br />1+15 htest 3'th Street <br />krrarLU 151ST]Ll ~v eorasxa bLSt5U1 <br /> <br />fund of Tax <br />Tax Period Ended <br />i>Rate of Assessment <br />identffying Number Unpaid 8alence <br />of Assessment <br />[a) <br />441 - 01 fb) <br />7903 [c) <br />0 ftll i <br />[e) <br /> <br /> <br />i 9-~+ 79 ~ 47-x591650 <br /> <br /> <br />j ~ $2,639.11+ <br />C <br />!'lace of Filing <br />$egiater pf peeds I <br />Hal]. ¢ounGy T~af ~ ~ 2, 639.11,. <br />Grand, Island, Nebraska 68801 <br />.,.,. _ t <br />J <br /> <br />