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01/13/2010 WED 14:45 <br />~~ <br />Form 6613 (Y)(c) <br />(Rev. February 2004) <br />~ ~ y L --------- <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Number <br />SMALL BIISTNESS/SELF EMPLOY~p AREP, #4 <br />Lien Unit Phone; (800) 829-3903 612224009 <br />As provided by section 6321, 6322, and b323 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 far 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 FIRST AMERICANS INSURANCE GROUP INC <br />Residence p0 BOX 2 0 8 5 <br />GRAND ISLAND, NE 68802-2085 <br />For Optional Use b Recording Office <br />NE SBC ai 5lsia Jphn p p~~~ <br />- uct ~r~ <br />9910816625-6 Pgg: 1 <br />FIRST AMERICAS INSURANCE CROUP <br />Filed; 01/13/2010 01:y4 PM <br />201000312 <br />IMPORTANT RELEASE INi:ORMATION: 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 as a certificate of release as defined <br />in IRC 8325(a). <br />Tax Period Date of Last Dayy for <br />Kind of Tax Ending Identifying Number Assessment Itefiling <br />(a) (b c d (e) <br />11zo lz/31/zoo2 47-077773s 10/13/2008 11/12/zols <br />CIVP 12/31/2006 47-0777735 09/14/2009 10/14/2019 <br />Place of Filing <br />FAX 402 471 4429 UCC SECRETARX OF STATE ~yy Hall <br />Total ~$ ].25153.90 <br />This notice was prepared and signed at <br />the 31st day of December <br />Signature ~ <br />for MICHAEL W. COX <br />2009 <br />faJ0A4/OOS <br />on this, <br />ACS <br />(800) 829-3903 <br />24-00-0008 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is nat_essentfal to the validity of Notice of Federal lax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 4091 <br />Part 1 w Kept By Recording Office Farm 668(Y)(c) IRev. 2-2004) <br />CA7. NO B0025X <br />CHICAGO, IL <br />unpaid Balance <br />of Assessment <br />124118.90 <br />1035.00 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1682 <br />