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Q~~++pp Department of the Treasury • tnternW Revenue~9erv~ca <br />roan ~[7v . <br />(Rev. September 1976) I+I~iCe of Federal Tax Lien Under Internal Revenue Laws <br />Serial Number ~ For onr;oner use w Rscorem9 orr) <br />District 3$219 <br />o(aaha 47 ~ ~ --° ~ ~~ 13 ~ 1 <br />As provided by sections 632'1, 6322, and 6323 of the Internal Revenue Code, <br />notwe is given that taxes tinciuding interest and ~nalties) have been assessed <br />against the fottowing-named taxpayer. Demend for payment of this 1'sability has <br />bean made, but it remains unpaid. Therefore, thaTe is a Lien in`favor oY the Uorn fed <br />States on all property and rights to property belonging to this taxpaye <br />amount of these taxes, and additional penalties, interest, and costs that may <br />accrue. <br />! Name of Taxpayer <br />Jens Rojewski <br />tidence 1310 North Hancock <br />Grand Tsiand~ NE 68801 <br />Kind of Tax Tex Perlad Ended D84e ~ toAtnertt <br />CeJ CDr <br />667z-17 8009 i 03-x3-81 <br />ide~iiying Number w fPD° <br />(dl Ce) <br />NME 508 3o-z9zbN $ 7687.38, <br />Place of Filing Register o£ Deeds <br />Hall. County Iota! ~ S 768'7.38 <br />Grand Islartdr NE 68801 <br />Grand Island, Nebraska__ 68801 _, .___--- --. on this, <br />This notice was Prepared artd signed at __ <br />the 17th ~yof March ~ ,59 81 __ _ <br />,~~~~ :Title <br />Signature ~, <br />_ 4 I Revenue officer <br />i <br />(puN: Certificate of orricar aurfrorixed ny taw to take atknow/adgmen s <br />FWefal Tax L;en O.C.M. 26319, 1950 a, C.B. 125.) <br />Form ti68 (Rev. 378) <br />PsR ~ - To be kept by recording office <br />L.~ <br /> <br />