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01/29/2010 FRI 14:55 FAX 402 471 4429 UCC SECRETARY OF STATE yM» Hal7. <br />lrL <br />X003/004 <br />3592 <br />Form bb8 (Y)(t) <br />IRev. February 2004) <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Number For Optional Use b Retarding Office <br />SMALL BUSINESS/SELF' FMPLOXBD AREA #4 <br />Lien Unit Phone: (8001 9~~-6oso ~ssa~z6lo <br />As provided by section b3Z1, b322, 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 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 for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer JAMES SLOGGETT <br />SLOGGETT PAINT & BODY <br />Residence 229 WILLOW ST <br />GRAND ISLAND, NE 68801-1321 <br />IMPORTANT RELEASE INFORIHATI~N: Far 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 <br />Kind of Tax Ending Identifyinig Number Assessment Reflling <br />(a) (b (c) d) (e <br />941 09/30/2009 20-5350069 12/07/2009 01/06/2020 <br />Place of Filing <br />NH Sre 4f 5lat~ .john P G~lr - UK FTL <br />9930618372-1 P9s: i <br />SLOGGET7 dRMES <br />Filsd: 01f29l2010 10:46 AM <br />~. <br />~.., <br />;. <br />~. <br />Unpaid Balance <br />of Assessment <br />;. <br />303.98 <br />Rega.ster of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />2oiooose~ <br />Total ~ $ 3 03 .9 8 <br />This notice was prepared and signed at <br />CHICAGO, IL <br />the __ _21st day of January 2010 <br />-. , <br />nn this, <br />Signature ~ H i~~ REVENUE OFFICER 24-10-1.720 <br />for DANIELLE L MUELLER (402) 473-4675 x2912 <br />(NOTE: Cenificata 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, 1971 - 2 C.B. 4091 Form d68(Y)(t) (Rev. 2-2004) <br />Part 1 -Kept By Recardfn6 Office CAT. NO 60026X <br />