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03/24/2p10 COED 15:21 <br />Farm 668 (Y)(c) <br />(Rev, February 2004) <br />14540.26 <br />6575.56 <br />F'`rBa: Serial Number <br />SMALL BUSINESS/SELF EMPS~OYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 634158710 <br />As provided by section b3Z i, 632, and b323 of the Internal Revenue <br />Cade, we are giving a notice that taxes (including interest and penalties) <br />have been assessed against the follawing~named taxpayer. We have made <br />a demand for payment of this IiabiGty, 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 tfie amouint of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer PASCUAL RAMIREZ RAMIREZ <br />Residence p0 BOX 2381 <br />GRAND ISLAND, NE 68$D2-2381 <br />For Optional Usk by Recordinc Office <br />N¢ Sre of S1.4r Jahn R G.le - uCC F7L <br />8910822986-e Pgs; i <br />Ft1MidEZOgA24/R2010 018 pM <br />IMPORTANT RELF,AS~ INFORMATION: For each assessment listed below, <br />unless notice of the lien is refited 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 6825(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 />1040 12/31/2000 XXX-XX--9587 09/0.4/20p6 10/D4/2016 <br />_1040 12/31/2DD2 XXX-XX-95$7 09/04/2006 10/04/2016 <br />Place of Filing <br />Register of Deeds <br />Hall POSOX 1692 <br />Grand Island, NE~68802-1692 <br />Department of the Treasury -Internal Revenus Service 2 010 ~ 19 5 9 <br />Notice of Federal Tax Lien <br />Total ~ $ 21115 .82 <br />This notice was prepared and signed at <br />the 12th day of March <br />Signature <br />for KA.Y <br />Title <br />REVENUE OFFICER <br />(308) 384-4850 <br />Unpaid Balance <br />of Assessment <br />24-10-1739 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 77-468, 7971 - 2 C_6. 409) <br />Part 1 -Kept By Recording Office Form 668(Y)(c) (Rev. z-2004! <br />CAT. NO 60026X <br />CHICAGO, IL <br />2o1D <br />on this, <br />FAX 402 471 4429 ryCC SECRETARY OF STATE ~ww Hall <br />I~oo4/op4 <br />