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01/27/2010 WED 15:25 FAX 402 471 4429 UCC SECRETARY OF STATE -+w~ Ha11 <br />form d68 (Y)(c) <br />(Rev. February 20p4) <br />For Optional Use by Recording Office <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax lien ~ 2 010 0 0 5 8 8 <br />Area: Serial Number <br />SMALL BUSSNESS/SELF EMPLOYED A1tEA #4 <br />Lien Unit Phone: (800) 829-3903 617726710 <br />As provided by section 6321, 6322, and 6323 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 for 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 far the amount of these taxex, and <br />additional penalties, interest, and casts that may accrue. <br />Name of Taxpayer <br />Residence 1116 W OKLAHOMA AVE <br />.. GRAND ISLAND, .NE 6$$01-6651 <br />N6 Sec of Silaka Jehn R 6.1• - N[C KTL <br />9910617922-7 Pgs: 1 <br />CA5TfWEDR JE5U5 <br />Filed: 01/27/2010 10:08 AM <br />X002/002 <br />IMPQRTANT RELEASE iNFORMATI~N: Far each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this native 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 <br />Kind of Tax Ending Identifying Number Assessment Refiling <br />(a) (b) (c) d) (e) <br />940 12/31/200$ 20-3855452 05/04/2009 06/03/2019 <br />941 7.2/31/2008 20-3856452 04/27/20D9 05/27/2019 <br />941 03/31/2009 20-3$56452 06/15/2009 07/15/2019 <br />Place of Filing <br />.idyl <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />375.52 <br />9414,11 <br />7791.35 <br />Total ~$ 175$0.98 <br />This notice was prepared and signed at <br />the 19th day of _ January <br />CHICAGO, IL <br />2D1D: <br />an this, <br />Signature ~ A ~ Title <br />ACS 24-DO-0008 <br />fox' MICHAEL W. COX (800) 529-3903 <br />(NOTE: Certificate of officer authorized by law tD take acknowledgment is not essential to the validity of Notice of Federal Tax lien ~ i <br />Rev. Rul. 71-468, 1971 - 2,G.6. 409) Fnrm 66A(V\h\ 1ae„ ~_~nnnl J <br />Unpaid .Balance <br />of Assessment <br />