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08/17/2010 TU13 12:02 FAX 402 471 4429 UCC SECRETARY OF STATE ~yy Hall <br />Form b6$ (Y)(t) <br />IRsv. February 2004) <br />201005824 <br />Area: Serial Number For Optional Use <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 686712610 <br />As provided by section 632 t, 6322, and 6323 of the Internal Revenge <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, bat it remains unpaid. Therefore, <br />there is a lien in favor of the United States on all property and rights to <br />property belonging W this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />ame of Taxpayer <br />~ ~ L ---- <br />Department of the Treasury -Internal Rovenue Service <br />Notice of Federal Tax Lien <br />Residence 7687 N 130TH RD <br />CAIRO, NE 68$24-9466 <br />IMPORTANT RlrLEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e1, this notice shall, <br />an the day following such date, operate as a certificate of release .as defined <br />in IRC 63251a). <br />T P 1 <br />cwth' JASON ~'9IS: f <br />Filed: OB/17/20t0 09:07 AM <br />Unpaid Balance <br />of Assessment <br />~D03/004 <br />Office <br /> <br />Kind of Tax ax er ad <br />finding <br />Identifying Number Date of <br />Assessment Last Dayy for <br />Refiling <br />(a) (b (c) d (e) <br />x.040 12/31/2005 XXX-XX-7116 09/21/2009 10/21/2019 <br />1040 12/31/2006 XXX-XX-7116 03/09/2009 04/08/2019 <br />Place of Filing <br />Register of Deeds <br />Ha,11 POBOX 16 9 2 <br />Grand Island, NE 6$802=1692 <br />92]..09 <br />21480.62 <br />Total ~$ 22401.7]. <br />This notice was prepared and signed at <br />the 06th day of August <br />Signature ~ <br />for MICHAEL W. COX <br />2010 <br />CHICAGO, TL <br />on this, <br />ACS <br />(800) 829-3903 <br />24-0o-ooos <br />inv. c: ~.er[mcac9 Ot omcer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - Z C.13. 409) <br />Part 1 -Kept gy Recording Office Form bb8(Y)(c) (Rev. 2-2004 <br />CAT. NO 80025X <br />