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10/27/2010 WED 14:08 FAX 402 471 4429 UCC SECRETARY OF STATE - Hall 0003/006 3592 Department of the Treasury - Internal Revenue Service Farm boar (Y)(c) (Rev. February 20041 Notice of Federal Tax Lien 201007946 Area: Serial Number For Optional Use by Recording Office SMALL BUSINESS/SELF EMPLOYFb AREA #4 Lien Unit Phone: (800) 913-6050 709080510 wa SK ar 340i"°F'""a•'' - As provided by section 6321, 6322, and 6323 of the internal Revenue Code, we are giving a notice that taxes (including interest and penalties) have been assessed against the following-named taxpayer. We have made ' a demand for payment of this liability, but it remains unpaid. Therefore, there is a lien in favor of the united States on all property and rights to WATERMAN DEBRA K property belonging to this taxpayer for the amount of these taxes, and Filed: 10127l2ete 09:00 AM additional penalties, interest, and costs that may accrue. Name of Taxpayer DEBRA K WATERMAN Residence 519 ROUSH LN GRAND ISLAND, NE 68$01-2210 IMPORTANT RELEASE INFORMATION: For each assessment listed b]shall, .unless notice of the lien is refiled by the date given in column (e), this notice an the day following such date, operate as a certificate of release as dein IRC 6325(a). Tax Period , Date of East Day for - unpaid Balance Kind of Tax Ending Identifying Number Assessment Reflling of Assessment a b) c) d) a 1040 12/31/2009 XXX-XX-7772 09/13/2010 10/'13/2020 378.92 F~ i.- Place of Filing Register of Deeds Hall POBOX 1692 Total $ 378 - 92 ' Grand Island, NE.68802-1692 This notice was prepared and signed at CHICAGO, IL on this, i. . the 08th day of October 2010 Signature A Title REVENUE OFFICER 24-10-1744 for PATRICK T KELLOGG (308) 384-4850 (NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien Rev. Rul. 71-466, 1971 - 2 C-B. 409) Form b68(Y)(C) (Rev. 2-20Q4) Part 1 - Kept By Recording Office CAT. NO 60025X