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oi�o5�zoii +�n �a:36 FAx aoz a�i aaz9 ucc SECRBTARX 08 STATE ��y H�ii <br />�Form 668 (Y)(cj <br />(Rav. Februdry 2004) <br />Area: Serial Number <br />SMALT, F3USINESS/SSLF }'sMPLOYED AR�P, #4 <br />Lien Unit Phone: (800) 913-6050 739052310 <br />As provided by section 63�1, b322, �nd b'�23 of the internal Revenue <br />Code, w� are �iving a notice that taxes (includin� interest and penalties) <br />have been assessed against the fo�lowing-named taucp�yer. We have made <br />a demand for payment af #hit liability, Iwt it remains unpaid. Therefore, <br />there is a lien in favor of the united States on all property and �rights to <br />property lielonging to this Wxpayer for the amount of these taxes, and <br />addltional penaltles, interest, and costs that may accrue. <br />92 <br />Department of the Treasury - In#ernal Revenue Service <br />�llo#ite of Federal Taac Lien 2 01 � 0 4� 4 G <br />Taxpayer PATRICA A DARLING <br />Residence 2g42 N IIIERS AVE STE 5 <br />GRAND ISLAND, NE 68803--1219 <br />For <br />�003/009 <br />Office <br />N6 i�c af SiN� Jehn R 6�Is - UCC FTL <br />9831647Z84-1 Pes: 1 <br />DHRLING PRTRICIA p <br />Fllsd: 01l05/2011 12:25 PM <br />IMPqRTA�IT R�I,�ASE INFORMATION For each assessment listed below <br />unless notice of the ►ien is refiled by the date given in column (e); this nctice shall, <br />an the day following such date, operate as a certificate of release as defined <br />in IRC 6325(a>. <br />Tax Period � �ate c�f laxt Day for <br />Kind af Tax Ending ldentifying Number Ihssessment �i,efil�ng.. <br />(a) (b) c (d e <br />�040 ��/�i/zoo5 xxx-�c-�si�r 02/05/2p07 o�/o�r/aoi� <br />io4o �.2/�i/zoo� xxx--xx-���� as/a�/zoo� o9/a6/ao�� <br />so�o �2/�1/aoa� xxx-xx-��.i�r 05/25/2009 as/z�:/2oi9 <br />Place of Filing <br />Regxster of Deeds <br />Hal l POBOX �.6 9 2 <br />Gran Island, NE 58802-1692 <br />llnpaid Balance <br />of Assessment <br />14a9.18 <br />9199.59 <br />7ota1 I$ 1062$.77 <br />This notice was prepared and signed at CH�CAGO, IL <br />the �� day of � ecember 2p].0 <br />, on this, <br />Signature Title <br />��` R�,VENUE OFF�CER 2�#-10-174�4 <br />for PATRTCIC J KELLOGG (308) 384-4850 <br />(N07E: Certificate of officer authorized by law to tak� acknowledgmenc is nnt essential to the validity ot Notice ot Federal Tax lien <br />Rav. Rul. 71-466, 1971 - 2 E.Q. 409) <br />: Part 1- IKept Br Retarding C�Ffice �rm 6b8(Y)(c) IRav. 2-2004) <br />. CAT. NO 6002SX <br />