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1�/22/2010 MON 15:38 FAX 402 471 4429 UCC S�CRSTA1tY 0� STATS •wy Hdll <br />� <br />Form 668 (Y)(c) <br />tRev. �atiarv zaaat <br />Area: <br />WAC�E & TNVESTMENT AREA #2 <br />Lien Unit-Phane: (800) a29-�650 �2�a�6�ra <br />As provtded by secti�n 6321, E,322, and 6323 af the Internal Revenue <br />Code, w� awe ghrin� a noc�c� that taxex (includin� interest and penalt�es) <br />have been asses�sed against the follow[ng-nam�d taxpayer. We have Made <br />a dema�td for payment ot' this liability, but It remains unpaid. Therefore, <br />ther� is a lien in favar af the united States on all praperty and rlghts to <br />praperty belcngin�g to tbis ta�ayer far the amou�nt oF these taxes, and <br />additionat penatties, interest, and casts that m�ay accrue. <br />�1»�7 <br />�003/007 <br />Department of the Treasury - Internal Revenue Service <br />� 1Votice of Federal Ta�c Lien <br />Serial Number �ar Qptions <br />ame of Taxpayer <br />Residence 9�.5 E 1.4TH ST <br />GRAND ISLAND, NE 68$p1-2631 <br />IMPORTANT RE�.EASE INFORMATI�N: Far each assBSSment listed belaw, <br />unless notice of the lisn is refiled by the date given In catumn {e) this notice shall, <br />an the day fallowing such date, Qperate a� a certificeta of release as defin�sd . <br />in IRC fi325(a). <br />Tax P�riod . Date af Last �ay �or <br />Kind of Tax �nding Identitying Nunnbcr - Assessment Refiling <br />(a �) � (d) (�) <br />xo�o iz/3�/ZOa� xxx��x-a�.s� o4/xs/aoo� o�/�.�/zoi7 <br />�.aa�o a.z/�i/aoo� xxx-xx-Z�.�� o�/zs/zoos os/z�/ao�s <br />�04o x.z/�x/2oo� x�-�-��.5� o�/�.�/aoos o�/��/za�� <br />�,��4a �.2%31/2007 XXX-XX-2157 io/zo/�oos �.i/�.�/zo�s <br />Place of Filing <br />Register o� De�ds <br />Ha7.l POBOX 1692 <br />Grand zsland, NE 688o2-1692 <br />Use hy RecardinA Office <br />NE Sse of Sla1� Jahn R WI• - IlCC FTI. <br />I <br />9910643680-3 Pss: 1 <br />rRUax�.�.o MaRr a <br />F�tQd: ttrzzizm�e ms:me an <br />2oa.00s74� <br />Total I $ <br />This notice was prepared and signed at CHTCAGO, IL <br />the ���h day of November . 207.0 <br />Signature <br />for PAMELA J ROGERS <br />ACS <br />(800) 8 <br />�:�� t+�� <br />1293.85 <br />7574.1& <br />� <br />, on this, <br />14-QO-0000 � <br />Llnpaid Balance <br />c►f Assessmeni <br />(NOTE: Cert(ficate of pfficer authvrized by (aw to take acknowledgment is not essentlal to the validity ot Notice of Federal Tax lien <br />Rev. Rul. 79-466, 1871 - 2 C.B. 409) Farm b68(Y)(t) {Rev. 2-200�11 <br />Part I• Kept By ttecording OF[ice CAT. ND 600�5X <br />