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05/21/2010 FRI 15:09 FAR 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br />V~ <br />Qj002/003 <br />Form d68 (Y)(c) <br />f Rev. February 2D04) <br />3592 <br />IJepartment of the Treasury -Internal Revenue Service <br />Notice of Federal Tax Lien 2 ~ 10 0 3 4 9 8 <br />Hrea; Serial Number <br />SMALL BUSINESS/SELF EMPLpYED AREA #4 <br />lien Unit Phone: (800) 913-6050 654293610 <br />As provided by section 632 i, 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 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 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 ROGELIO FUENTES <br />Residence 1603 W JOHN ST <br />GRAND ISLAND, NE 68801-6322 <br />For Optional Use by .Recording ptfice <br />_ ucc FTL <br />i~ John P 6atir <br />Ni fro of it: <br />Pss: 1 <br />9910627949-5 <br />Filad.606/~12010 10:63 AM <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 6325(a). <br />Tax Period Date of Last Dayy far <br />Kind of Tax Ending ..Identifying Number Assessment Refiring <br />Unpaid Balance <br />of Assessment <br />1040 12/31/2002 XXX-XX-661.6' 02/27/2006 03/28/2016 4317,63 <br />1040 12./31./2003 XXX-XX-6616 02/27/2006 03/28/2016 11016,69 <br />1040 12/31/2004 XXX-XX-6616 12/08/2008 01/07/2019 ].6$06.35 <br />1040 12/31/2006 XXX-XX-6616 11/16/2009 12/16/2019 11956,33 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ 44097.00 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at CHICAGO, IL <br />on this, <br />the 10th day of May 2 010 <br />Signature A Title <br />REVENUE OFFICER 24-10-1744 <br />for PATRICK J KELLOGG (308) 384-4850 <br />(MOTH: Certificate aF 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. 4091 <br />Part 1 -Kept ey Recording Oft7te Form 668(Y)(c) IRev. 2-20041 <br /> CAT. NO 60025X <br />~~ <br />