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11/22/2010 MON 15:3$ FAIt 402 471 4429 �CC S�CRBTARY pF STATE y�y Hall <br />� 3592 <br />Department of the 1"reasury - Internal Revsnue Service <br />Farm Qb8 (Y)(c) <br />4R��. �e��.ua� �ooa� Not�ce of Federat Ta�c Lien <br />Area: Serial Number � For opuons <br />SMALL BUSIN�SS/SEI.�F EMPLOX�b AR�A ##4 <br />Lien Unit Phane: (800> 913-6o5p 719p32810 <br />As provided by section 6321, l53z2, and 63Z3' of the Internal Revenue <br />Code, w� are giving a nocice that taxes (including interest ancl perraltles) <br />have been asxessed against the followtng-named taxpayer, We have made <br />a demand far paymenc oE this liability, but it remains unpaid. Therefare, <br />there �S a Ilen in favar of the unit�d Scates on a11 property and• rights ta <br />property be[anging to c�tis taxpayer �ar the amount of these ta�ces, and <br />additioaal penalties, interext, and costs that may accrue. <br />Name of 7axpayer poUGLAS B EHLERS <br />Use by Recording Office <br />NE S�c of 5ia�r Jahn N 6ele - IILC FTL <br />9810643579-0 P9s� 1 <br />EHLERS DOLIGLRS B <br />Flled: 11/22l2010 09:08 HM <br />�0104874G <br />Residence gQg W SOUTH FRONT ST APT 3 <br />GRAND ISL��TD, 1VFs 6gg01-4769 <br />IMPORTANT REI,�,A,SE INFORMATION: Fvr aach assessment listed below, <br />unless nqtice of the lien is refiled by the date 'pivan in calumn ie); this notice shall, <br />on the day fallowing &uch date, npe�ate as a certificate o•f release as defined <br />irt IRC 6325{a). <br />Tax Periocl Date af M.ast Day far <br />Kind af Tax Ending identifying Number Assessment Ref�ling <br />10�40 12/31/2p05 <br />1440 12/3�./2006 <br />io�o ia/3�./2007 <br />Place of Filing <br />�002/007 <br />(� <br />XXX-XX-7Q70. <br />XXX-XX-7q7Q <br />xxx-xx��o�o <br />a.�/2z/�aos px/z�/�oi� <br />05/1�/2Q09 06/10/2Q19 <br />o�/xa/zoio 0�/o9/2a�o <br />Register of Deeds <br />Hall POBOK 1692 <br />Gr and Tsl.and, NE 688A 2-15g2 <br />unpaid Balance <br />of Assessment <br />8195.00 <br />a�ro�.i� <br />9324.83 <br />� <br />Total � $ 26226 . 97 <br />This noCiCe was prepared end signed at <br />the n �� h day of November <br />Signature <br />for DANTELLE L <br />201Q <br />CHICAGO, TL <br />, an this, . <br />Title <br />REVENUE OFFICER 24-10-1720 �^ <br />(402) 473-�4675 x29�2 ,� <br />�...+.... va.uu�.w�o v� �����C� ���„��,�d� oy iaw �o �aKa acKnowieqgment is �ot esssntial [o the validity of NotiCe of �ederal Tax lien <br />Rev. Rul. 71-A.66, 1971 - 2 C_B. 409) <br />Part 1- Kept By ReCOrding O(fEt� Fp� bb$(Y)(c) (Rev. 2-2004) <br />CAT. NO 600Z5X <br />