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01/20/2010 OPED 15:34 FAX 402 471 4429 UCC SECRETARY' pF STATS w-+a Hd11 <br />V <br />Form 668 (Y)(c) <br />IRev. February 20041 <br />3592 <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal. Tax Lien <br />Area: Serial Number Far Optional Use b Recvrdin pffice <br />SMALL 8[T$INESS/SELF BI~PI,,OXED AREA. #4 <br />Lien Unit Phone: (SOp) 829-3903 6x39338].0 Na s.G ar s~.t. ,on„ a a4i. - ucc Fn <br />As provided by section 6321, 6322, and 63x3 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 llnlted States on all property and rights tv 8910617353-0 Pas = 1 <br />property belonging to this taxpayer for the amount of these taxes, and ~iladNC01/20/2010 01:49 PM <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer FLS TNC <br />Residence 4 014 BUCKINGHAM DR <br />GRAND ISLAND, NE 68803--6401 2 Q 1 Q ~ ~ ~ ~ i <br />IMPORTANT Ri:LEASF INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this Halite shall, <br />on the day following such date, operate as a certificate of release as defined <br />in iRC 6325(a). <br /> Tax Period Date of bast Day far unpaid Balance <br />Kind of Tax Ending identifying Number Assessment Refiling of Assessment <br />(a (b) c d) e) <br />941 12/31/2008 20-5783258 04/06/2009 05/06/2019 1106.55 <br />941 03/31/2009 20-5783258 06/29/2009 07/29/2019 7260.73 <br />Place of Filing <br />Register of Deeds <br />Ha11 POBOX 1692 Total $ 8367.28 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />the 07th day of January <br />Signature A Title <br />ACS 24-00-0008 <br />for MICHAEL W. COX (800) 829-3903 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien ~: <br />Rev. Rul. 71-466, 1977 • 2 C.9. 409) Form 668(Y)(C) IRev. 2-2p04- <br />Part 1 -Kept By Recarding Office CAT. NO fi0025X <br />CHICAGO, IL <br />2010. <br />1,003/007 <br />on this, <br />