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O1/1$/2011 TUE 14:22 FAx 402 471 4429 UCC SSCRETARY OF STA�E ��y H�l� <br />�V <br />Forro b68 (Y)(t) <br />(Fiev. Fe6ruary 200�4) <br />�J003/005 <br />92 <br />Department of the Treasury - �ntarnai Ravenus Service 2 0�� / <br />Not��e of Feder�al �� l.ien � 0 `� 1 r( <br />Area: Serial Number <br />sr�z� avs�rrsss/ss�� �r.a�rrn � #�: <br />Lien Unit Phane (800) 913-6050 739065911 <br />As provicled by section 6321, b32Z, and b32� of the Internal Revenae <br />Code, we are giving a notice that wxes (including interest and penaldes) <br />.have been assessed against the foil�ing-named taxpayer. We have made <br />a demand far payment of this Itability, but it remains anpaid. Therefor�, <br />there is a lien in rtavar of tl�e united 5tat�s on all property and rig�hts to <br />property belonging w this taxpayer for the amount af these �ax�s, and <br />additionat pen�alties, interest, and casts that may accrue. <br />--- •�...� <br />ame of Taxpayer <br />Residence g23 U�1 1ST ST <br />GRANI) ISLAND, NE 688Q1-580,9 <br />Far Oational Use by Recording Offica <br />NE See Of 5��ir John R G�1• « UCC FiL <br />9911648470�7 Pgs: 1 <br />MCCL.OUD RE6INAL� <br />Filad: 01l18/2011 08:61 RM <br />IMP�RTANT REI.EAS� INFORMATION For each assessmerrt li�ted below, <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, nperate as a certificate of release as defined <br />in IRC 83251a). <br />Tax Pe�iod Dase a� [.ast �ay for <br />Kind of Tax Ending Identifying Number Assessntent Refiling <br />so�o �a/�i/zooa xxx-xx-3�.�0 os/��/aon4 o�/is/ao�4 <br />1040 12/31/2004 XXX-XX-3110 12/2p/2010 �1/19/2021 <br />1040 12/31/20p5 XXX-XX-3110 12/20/2b10 01/19/2021 <br />Place of Filing <br />llnpaid Balance <br />of Assessment <br />37.58.31 <br />53$6.09 <br />22Q8.54 <br />Regis�er of Deeds <br />Ha�.1 PoBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total I$ 1Q752.94 <br />This notice was prepared and signed at <br />the �� day of January <br />2011 <br />CHICA,GO, IL <br />, on this, <br />Signature �rt` REVENUE OFFICER 24-7.0-1744 <br />for PATRICK J KELLOG (308) 384-4850 <br />(NOTE: Certificate of officer authorized by law to take ackr►awledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) <br />PA�'t 1- KRpt By ReCqrdin$ Of�9t� Form �b8(Y)(c) (Rev. 2�2004) <br />CAT, NO 60025X <br />