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09/20/2010 MON 15:08 <br />Form 668 (Y)(c) <br />(Rev. February 2D04) <br />FAX 402 471 4429 []CC SBCRBTARY OF STATE yyy Hall <br />X002/003 <br />592 <br />Department of the Treasury -Internal Revenue Seri N~ sQC ,~ sE.+. ,,,,,,, p ~~,, _ ~~~ cT~ <br />Notice of Federal Tax Lien <br />Area: Serial Number For Op <br />WAGE ~ INVESTMENT AREA #2 <br />Lien Unit Phone: (800) 829-7650 697205510 9910837801-5 Ps:: t <br />As provided by section 6321, 6322, and 6323 of the Internal Revenge Fu~~~s 09R20N20 0J11~90 fiM <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 Statex an all property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and cosu chat may accrue. <br />Name of Taxpayer JOSE J QUILES HERNANDEZ <br />201006828 <br />Residence 415 W 11TH ST <br />GRAND ISLAND, NE 68801-3734 <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 D for <br />Klnd of Tax Ending Identifying Number Assessment Refi~ng <br />Unpaid Balance <br />of Assessment <br />1040 12/.3]./2003 XXX-XX-4176 08/08/200$ 09/07/2018 2537.42 <br />1040 x.2/31/2004 XXX-XX-4176 05/24/2010 06/23/2020 1,551$.02 <br />1040 12/31/2005 XXX-XX-4176 08/18/2008 09/17/201$ 27479.97 <br />1040 12/31/2006 XXX-XX-4176 05/24/2010 06/23/Z020 32369.57 <br />Place of Filing <br />Register of Deeds <br />Ha11 POBOX 1692 <br />Grand Island, NE 6$802--1692 <br />Total ~$ 77904.98 <br />This notice was prepared and signed at <br />CHICAGO, IL <br />the 07th day of September 2010 <br />on this, <br />Signature A Title <br />ACS 14-00-0000 <br />for PAMELA J ROGERS (800) 829-7650 <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. 77-466, 1971 • Z C.B. 409) Form 668(Y)(r.) (Rev. 2-2D04- <br />Part 1 -Kept sY Recording Office CAT. N<1 6ot)25X ,1 <br />.~ <br />