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06/24/2010 THU 14:09 FAX 402 471 4429 UCC SECRETARY OF STAT]~ ~~~ Ha11 <br />I;~J003/004 <br />~ 3592 <br />Department of the Treasury -Internal Revenue Service <br />Form 668 (Y)(c) Notice of Federal Tax t,ien <br />(Rev. February 2004) <br />/!-r8a' Serial Number For pptional Usa by Recording Office <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit F'hone: (800) 913-6aSO 557385510 Na s^~ o. SH4e Jehn R On1~ .. UC[ FTL <br />As provided by section b321, 6322, and b323 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 ro r and ri is tv <br />p ~ ty ~ seiesam6as-z Psi; 1 <br /> <br />property belonging t0 this taxpayer for the amount of these taxes, and cook ~o>wl. q <br />Filed: 06/24/2010 10;55 qM <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer JOEL A & TRACI L COOK <br />Residence 61 s HERMITAGE PL 2 010 0 4 3 9 <br />GRAND ISLAND, NE 6$801-$604 <br />IMPORTANT RhLIrASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is raffled by the date given in column (al, 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 Day for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Raffling of Assessment <br />(a) (b (c) (d) (e) (f <br />1040 12/31/7,999 XXX-XX-5446 01/12/2009 02/11/2019 <br />1040 12/31/1999 XXX-XX-5446 02/09/2009 03/11/207.9 5354.99 <br />1.040 12/31/2000 XXX-XX-5446 01/05/2009 02/04/2019 5447.47 <br />1040 12/31./2001 XXX-XX-5446 01/05/2009 02/04/2019 9356.57 <br />1040 ~ 12/31/2002 XXX.--XX-5446, 03/09/2009 04/08/2019 7490.00 <br />1040 12/31/2003 XXX-XX-5446 03/09/2009 04/08/2019 7858.50 <br />1040 12/31/2004 XXX-XX-5446 03/09/2009 04/08/2.019 899.14 <br />1040 12/37./2007 XXX-XX-5446 12/01/2008 12/31/2018 1242.73 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ 37649.40 <br />Grand Is7.and, NE 68802-1692 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 15th day of June 2010 <br />Signature ~ Title <br />REVENUE OFFICER 2410-1720 <br />for DANIELLE L MUELLER (402) 473-4675 x2912 8 <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.g. 4091 Form 668(Y)(c) (Rev. 2-2004) <br />Part 1 -Kept By Recording ~ce CAT. NO 60025X <br />