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03/01/2010 MON 15:27 FAR 402 471 4429 UCC SECRETARY OF STATE ~y~ Hall <br />X005/008 <br />- 3592 <br />Department of the Treasury -Internal Revenue Service <br />Form 668 (Y)(c) Notice of Federal Tax Lien <br />IRev. FeBrusry 2Q041 <br />Area• Serial Number For Optional Use by Recording Office <br />SMA>aL $USINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (aoo) 913-6DS0 6281$7910 ' <br /> NC f~a of f!a{a Jmhn A 6.Ie - 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 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 /> <br />~aperty belonging to this taxpayer for tbp: amoltutt~ of thea~,~ice~ and 9910621114-0 pas: 1 <br />R <br />~iieaa'aaim <br /> <br />additional penalties, interest, and costs that may accrue. i <br />Zmio im:a~ ar, <br />Name of Taxpayer MARIO R PEREZ <br /> 201001335 <br />Residence PO BOX .744 <br />GRAND ISLAND, NE 68802-0744 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e1, .this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 83254a). <br /> Tax Period Date of Last Day For unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refiling of Assessment <br />(a) (b) (c) d) e) (~ <br />1040 12/31/2004 XXX-XX-6053 10/31/2005 <br />k ..: <br />. .. 11/30/2015 <br /> <br />:: j" 1188.03 <br />Place of Filing <br />Register of Deeds <br />Ha7.1 POBOX 1692 Total $ 1188.03 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />the 23rd day of February 2010 <br />on this, <br />Signature A Title <br />REVENUE OFFICER 24-10-1720 <br />for DANIELLE L MUELLER (402) 473-4675 x2912 <br />CHICAGO, IL <br />(Na'rE: 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, 1971 - 2 C.B. 4D9) Form 668(Y)(c) IRev. 2.2DD41 <br />Part 1 -Kant By Retarding Ofiite ,,,,~ ,,,,, Q,,,,,,5v <br />