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08/10/2010 TU8 15:28 Form 668 (Y)(c) IRev. February 2004) FAX 402 471 4429 UCC SSCRSTARX OP ST.ATS ~~~ Hall X002/002 7L Department of the Treasury -Internal Revenue Sarvir:a NE ;ac eF SM~ia Jahn R 6a/e -UCC RTl Notice of Federal. Tax Lien Area: Serial Number SMALL BUSINESS/SELF EMPLOYED AREA #4 Llen Unit Phone: (800) 829-3983 683518310 As provided by section b321, b322, and 6323 of the internal Revenue eECKSareor)~ a ON a Pss: + Code, we are giving a notice that taxes (including interest and penalties) ilea. ms,+mizm+m +7:+e ~r+ have been assessed against the Falloyving-named taxpayer. We have made a demand far payment of this liability, but it remains unpaid. Therefore, there is a lien in Favor aF the United States on all property and rights to praperty belonging to this taxpayer For the amount of these taxes, and additional penalties, interest, and costs that may aarue. Name of Taxpayer JASQN A BECKSTROM Residence 2120 WILLIAM ST GRAND ISLAND, NE 68$01--7427 IMPQRTANT RELEASE 1NFORMATIQiV: For each assessment listed below, unless notice of the lien is refiled by the date given in column (el, this notice shall, on the day following such date, operate as a certificate pf release as defined in IRC 6325(a-. Tax Periad Date of Last Dayy for Kind of Tax Ending IdentiFying Number Assessment Refiling 1040 i12/31/2008I XXX--XX-6533 11/23/2009 12/23/2019 Place of Filing Register of Deeds Hall POBOX 1692 Grand Island, NE 68$02-1692 Total ~$ 8771.52 This notice was prepared and signed at the 29th day of July Signature ~ ~ for MICHAEL W. COX ACS (800) 829-3903 201005647 Unpaid balance aF Assessment 24-00--0008 CHICAGO, IL 2010 8771,52 on this, (NOTE: Certificate of officer authorized by law to take acknowledgment is no[ essential to the validity of Notice of Federal Tex lien Rev. Rul. 71.466, 1971 - 2 C.B. 4091 Form 668(Y)(c) (Rev. 2-2004) Part t -Kept By l~ecordipg OfFice CAT. N© 60025X