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01/22/2010 FRI 14:23 FAX 4D2 471 4429 OCC SECRETARY OF STAT>a ~~~ Hall <br />Form bb8 (Y)(c) <br />(Rea. February 2004) <br />i~002/004 <br />i <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien 2 0 ~. 0 0 0 4 9 7 <br />Area: Serial Number For Optional Use by Recvrdin pffice <br />SMALL BUSINESS/SELF' EMPLQXED ARIA #4 <br />Lien Unit Phone: (800) 913-6050 61606467.0 "c s.e ~+:t.t.,a,,,, p ce,. <br />UCC FTL <br />As provided by section b321, b322, and b323 of the Internal Revenue <br />Code, we are giving a notice that taxes (including interest and penaltiex) <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 ssxeat~gai-4 <br /> <br />property belonging to this taxpayer for the amount of these taxes, and a s: 1 <br />~lsiad O j A~ j)2010 ~ <br /> <br />additional penalties, interest, and costs that may accrue. ®c 50 ~ <br />~ . <br />Name of Taxpayer JAN--MIKEL T GRANDON <br />Residence 32g MATT,-ARD LN <br />GRAND ISLAND, NE 68801-8544 <br />IMPORTANT RELEASE INFORMATION: 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 6325(a). <br /> Tax Period Date of Last Dayy for unpaid Balance <br />Kind of Tax finding Identlifying Number Assessment Refili ng of Assessment <br />(a) (b) (c (d) (e) (~ <br />1040 12/31/2004 XXX-XX-3835 05/30/2005 06/29/2015 226.41 <br />Place of Filing <br />Reg~.st:er of Deeds <br />Hall POBOX 16 9 2 Total $ 2 2 6.41 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />the __ 13 t"h day of January <br />CHICAGO, IL <br />2010 <br />on this, <br />Signature ~ H ,~,~ RIEVENUE OFFICER 24--10-1720 <br />for DANIELLE L MUELLER (402) 473-4675 x2912 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Native of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 G.B. 409) Form 668(>n(c) (Rev. 2-2004) <br />Part t -Kept By Recording Office CAT, NO 60025X <br />