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12/Q9/2010 THU 15:2$ FAx 402 471 4429 ❑CC SBCR�TAI2Y OF STATE ��� Ha11 <br />�arm 6b8 (Y)(c) <br />lRav. Fe6ruary 2004) <br />35 <br />For <br />Area: $erial Number � <br />SMALL E3USZNESS�SELF EMPLOYEA ARFA #4 <br />L.ien Unit Phane: (800) 829-39Q3 . 725746D10 <br />As provid�d by section 6321, 632�, and 632� af the Internal R�evenue <br />Code, we are givtng a notke that taxes (Pincluding interest and penaltles) <br />have been assessed �gains� the fopowing-named taxpayer. Wye have made <br />a demand for payment o� t1��s Iiability, but it remalns unpaid. Tf�er�far�, <br />there �S a lien in favor of the llnited Swtes on al! prop�rty and rights to <br />prape�ty belonging #o thi: taxpayer for the amount of these taxes, and <br />additional penaltir�, interest, and costs that n�ay accr�ue. <br />me af Taxpayer SCOTT A <br />Residence ��g2 �RTFORD ST <br />GRAND ISLANA, NE 68803-2255 <br />�005/006 <br />201009208 <br />Use by Racordins� Office <br />ME Sar o� 5{�fo Jehn R 6ale <br />- ucc �� <br />99106q5044—g pgs: � <br />R�DWIIVE SC�TT A <br />Filad: 12/0g/Z�10 08:3g pM <br />IMPORTANT REI,EAS� (NFORMATIQN For each assessment listed below, <br />uNess notice of the lien is refil�d by the date given.in column (e), this notioe shatl, <br />on tha day following such date, operate as a certificate of release �s detined <br />in IRC 6325(a). <br />Ta�c Period Date of I.ast Day for <br />Kind af Tax EndYng Identifj►ing Num6er Assessment R�efiling <br />i�� .�. . . _ <br />xo4a �.2/31/2003 XXX-XX-0755 os/o4/zoos a�/o�/zo�a <br />].040 12/31/2006 XXX-XK-p755 08/10/2009 09/09/207.9 <br />1040 12/31/2007 xxx_-�-Q755 05/1Q/201Q 06/�9/2D20 <br />Place of Filing <br />Register of Deeds <br />Ha11 POBOX 1692 <br />Grand Island NE 66802-1692 <br />llnpaid Balance <br />of Assessment <br />11556.86 <br />5778,01 <br />5872.9g <br />Tatal �$ 23207.86 <br />This natice was prepared and signed at CHICAGO, �L <br />the Z �� h day af November 2010 <br />, on this, <br />Signature �` ACS <br />2�4-00--0008 <br />for MICHAEL W. COX (800) 829-3903 <br />(NOTE: Gertificate of officer authorized by law to take acknowledgment is not assential to the validity of Notice of Federal Tax (ien <br />Rev. Rul. 71-466, 1971 - 2 G,B. 409) <br />Part 1 - Kept By Recording OHIte �orm 668(n(cj (Rev. 2-2004) <br />• CAT. NQ 60025X _ • <br />Department of the Treasury - Internal Revenue Service <br />Notrce of Federal Tax L.ien <br />