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05/05/2010 WED 15:41 FAX 402 471 4429 UCC SECRETARX OF STATE yyy Hall <br />ia1002/003 <br />Form 668 (Y)(t) <br />(Rev. February 2004) <br />ybu / <br />Department of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 647903610 <br />As provided by section b321, 6322, and b3~3 of the internal Revenue <br />Code, we are giving a notice that taxes (including interest and penalties) <br />have been assessed against the fallowing-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 an 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 6$801-1321 <br />For Optional Use by Recording C)ffir.A <br />NE Sac of 5lr~n Jvhn A 6aly - W[C FTL <br />9910626405-2 p9s: 1 <br />SLOGGETT JAMES <br />piled: 05/05!2010 02:32 pM <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as a certificate. of release as defined <br />in IRC 63261a). <br />Tax Period Date of Last Dad~ for <br />Kind of Tax Ending identifying Number Assessment Refiling <br />(a) (b) (c) (d) (e) <br />941 03/31/2009 20-5350069 04/05/2010 05/05/2020 <br />Place of Filing <br />4867.87 <br />Register of Deeds <br />Hall POBOX 7.692 <br />Grand Island, NE 68802-7.692 <br />Total ~$ 4 8 6 7. 8 7 <br />This notice was prepared and signed at <br />the 22nd day of April <br />CHICAGO, IL <br />2010 <br />pn this, <br />Signature ~ f~ ~/y~~ Title - --- <br />REVENUE OFFICER 24-10-1720 <br />for DANIELLE L MUELLER (402) 473-4675 x2912 <br />(NOTE: Certificate of otficer authorized by law to take acknowledgment is not essential to the validity of Ngtice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form bb8(Y)(c) (Rev. 2-20041 ~, <br />Part 1 -Kept By Record(ng Office CAT. No 60025X <br />201003039 <br />Unpaid Balance <br />of Assessment <br />