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102/08/2010 MON 15:05 PAx 402 471 4429 UCC 58CRETARY pF STATE ~~~ Ha11 <br />CL __ <br />U 3592 <br />Department of the Treasury -Internal Revenue Service <br />Form 668 (Y)(c) Notice of Fedelral TaX Lien <br />(Rev. February 2004) <br />X006/007 <br />Area: Serial Number For Optional Use qy Recording Office <br />SIhALL BUSINESS/SELF EMPLDYED AREA #4 <br />Lien Unit Phone: {800) 913-6050 621389410 N~ s-C of Sk-kR Jor-, p W-:- . l1CC FTL <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 beenl assessed against the fallowing-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 roe and ri is to <br />p p ~ ~ ssiaslszes-~ asg: ~ <br /> <br />property belonging to this taxpayer for the amount of these taxes, and SANTIAGO ALEJANDR JUAN J <br />Filed: 02/08/2010 10:12 AM <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer JUAN J SANTIAGO ALEJANDR <br /> ~olooos~s <br /> <br />Residence 2219 W CAPITAL AVE <br />GRAND ISLAND, NE 68803-2002 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column fe), this notice shall, <br />o~ the day following such date, operate as a certificate of release as defined <br />in IRC 8325(al. <br /> Tax Period Date of Last Dayy for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refiling of Assessment <br />(a) (b) c d e) f) <br />1p40 12/31/2005 XXX-XX-9854 12/28/20.09 01/27/2020 38632.66 <br />1040 12/31/2006 XXX-XX-9854 12/28/2009 01/27/2020 24914.55 <br />1040 12/31/2007 XXX-XX~9854 02/25/2008 03/27/2018 <br />1040 12/31/2007 XXX-XX-9854 12/07/2009 01/06/2020 13240.21 <br />Place of Filing <br />Register of Deeds <br />Ha11 POBOX 1692 Total $ <br />Grand Island, NE 68802-1692 <br />76787.42 <br />This notice was prepared and signed at CHICAGO, IL <br />the 28th day of January 2010 <br />on this, <br />Signature ~ A ~Yy~ Title <br />REVENUE OFFICER 24-10-1739 <br />for KAY PONTE (308) 384-4850 <br />N :Certificate of officer authorized by law to take acknowledgment is not essential.to the validity of Notice of Federal l'ax lien <br />Rev_ Rul. 71-466, 1971 - 2 C.e. 409) Form 668(1f0(t) (Rev. 2-2004) <br />`J <br />Part 1 -Kept BY i!tetordieg Office CA7. NO 60025X <br />