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08/30/2010 MON 15:56 FAK 402 471 4429 UCC SECRETARY OF STAIR ~~~ Hall <br />Form bba (Y)(c) <br />(Rev. February 2004- <br />3 <br />Department of the Treasury -Internal Revenue Service Nr S.K of s~.t, Jeh <br />~ R 6~t~ . <br />Notice of Federal Tax Lien <br />Area: Serial Number For gpuar <br />SMALL BU$~NESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 690821410 9810gg600S_ <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue slid" 0~~~~6 01Q ~ <br />Code, we are giving a notice that taxes (including interest and penalties] f f ° ~ art <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 11en in favor of the United States on all property and rights to <br />property belonging to this taxpayer for the amount of then taxes, and <br />additional penalties, interest, and costs that may accn~e. <br />Name of Taxpayer ANGEL & MARIA HERNANDEZ <br />Residence 415 S JEFFERSON ST <br />C3RAND ISLAND, NE 6$801-641G <br />IMPORTANT RELEASE INI:ORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e1, this notice shall, <br />on the day fallowing such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />Talc Period Date of Last Dayy for <br />Kind of Tax Ending Identifying Number Assessment ReFiling <br />a) (b) (c) d e <br />1040 12/31/2005 XXX-XX-5223 05/12/2008 06/11/2018 <br />Place of Filing <br />Rega.ster of Deeds <br />Hall POSOX 1692 <br />Grand Island, NE 68802-1692 <br />2003.fi9 <br />Total I$ s 2003.69 <br />This notice was prepared and signed at <br />the 19th day of August: <br />CHICAGO, IL <br />2010, <br />on this, <br />Signature ~ y ~~- <br />for DANIELLE L MUELLER <br />Title <br />REVENUE OFFICER 24--10-1720 <br />(402) 473-4575 x2912 <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. 71-488, 1971 - 2 C.B. 4U9) Form 668(Y)(c) IRev. 2-2004) <br />Part 1 -Kept By Recording Office CAT. NO 6o025X <br />X003/005 <br />~oloos2i5 <br />Unpaid Balance <br />of Assessment <br />G <br />~~ <br />ti <br />