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04/23/2010 FItI 15:43 <br />Form bb8 (Y)(c) <br />(Rev. F®bruary 2004) <br />FAX 402 471 4429 UCC SECRETARX OF STATE ~yy aa~.J. <br />Ia1002/003 <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien <br />Hrea: Serial Number <br />SMALT,, $USINESS/$ELF EMPLOYED AREA, #4 <br />Lien Unit Phone: (sop) 829-39p3 64157551p <br />As provided by section 6321, 6322, and 6323 of the- Internal Revenue <br />Cade, we are giving a notice that taxes (including interest and penalties) <br />have been assessed against the foilawing-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 RUSSELL 0 & LORI FORSYTHB ~7R <br />For Optional Use by ReGOrding Office <br />NQ See ei 5~w1e Jehn A O~l• UCG 6tt <br />99>;06Z5504~-i pis; 1 <br />F/Redm04R23s2010 03;10 PM <br />201002729 <br />Residence 4 014 BUCKINGHAM DR <br />GRAND ISLAND, .NE 6$803-6401 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column 1e), this notice shall, <br />on the day following such date, operate as a certificate af. release as defined <br />in IRC 8325(a). <br />Tax Period Date of Last Dayy for <br />Kind of Tax Ending Identifying Number ~ Assessment Refiling <br />._. ,.. _ <br />1040 I12/31/2008I XXX^XX-5413 11/23/2009 12/23/2019 <br />Place of Filing <br />Unpaid Balance <br />of Assessment <br />36368.83 <br />Register of Deeds <br />Hall FOBOX 1692 Total $ <br />Grand Island, NE 68802-1692 <br />36368.83 <br />This notice was prepared and signed at CHICAGO, IL <br />the 06th day of AprYl 2010 <br />Signature ~ <br />for MICHAEL W. CQX <br />ACS <br />(800) 829-3903 <br />24-00-0008 <br />on this, <br />~IV\.II C: ~ertilicate 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.9. 4p9) <br />Part 1 -Kept gy 1Retording ~ce Form 6b8(Y)(c) IRev. 2-2pp4) <br />I~AT N!1 faY'19FY <br />