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pl/19/2011 9�D 15:10 FAX 402 471 4429 UCC SECRETARY OF STATE �w� Hdll <br />� Forn� b6$ (Y)(c) <br />IRev. February 2004) <br />f�oo4�00� <br />C•] <br />Depar.tment af the Treasury - internal Revenus Service <br />Notite o� Federal Tax Lien <br />q�Q�; Seriai Number For opt�ona <br />BMALL HUSIN�SS/S�SLF' EMPLQYED ARRA #� <br />Lien Unit Phone: (8U0) 913-605� 7�1736111 <br />As provlded by section 632f, b322, and b323 of the lnternal Reverwe <br />Code, we are.giving a notice that taxes (including interest and penalties) <br />have beee asseued against tf�e following-named taxpayer. W� have made <br />a demand for pay�nent af this liabil�ty, but it renwins uepaid. Therefore, <br />there is a lien in favar of the �Inited States an all property and rfghts to <br />praperty belonging to this taxpayer for the amount of these taues, and <br />additianal penalties, interest, and toats tltat may accrue. <br />Name of Taxpayer NORMA C MORENO <br />Residence 107 CENTENNIAL DR <br />� � GRAND ISLAND, NE 6$801-2307 <br />(MP�RTANT RE6EAS� INFORMATtON For each assessment fisted below <br />unless nn#ice of the lien is refiled by the date given in column (a), this natice shatl, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(a). • <br />Tax Period Date of Last Day Far <br />Kind of Tax Endleg [dpntifying Nurober Assessnnent Refil"mg <br />�.o�o �.z/�1/zoo� xxx-�c=��4�r o�I��./ano�� o�/�.o/ao�.g <br />Place of Fili�g <br />Regis�er o� Deeds <br />Hal�. POSOX 1G92 <br />Grand Is].and, NE 68802-1692 <br />i�792.a� <br />2011004 )2 <br />993I6� <br />MORENO <br />�,i.a: <br />Total �$ 15792.27 <br />This nvtice was prepared and signed at <br />the ��� day of January <br />_�.— <br />Signature <br />for DAN�ELLE L <br />CHZCAG�, IL <br />zoli <br />tlnpaid Balance <br />of As�s4ssment <br />, on this, <br />7itle <br />REVSNUE OFFICSR 24-10-172D <br />(402) 473-�4675 x2912 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essentia� to tne vaua�xy vr �vo���� v� rauaiai � an ��a�� <br />Rev. Rul. �1-4B6, 1971 - 2 C.B. 4U9) Form 668(Y)(c) (Rev. 2-20D4) <br />part t• Kept By RRCOrdln$ Q�fiCa CAT. NO BOd25X <br />u$e <br />cOrding QtF1C8 <br />m R 6si• - UCC FTL <br />Pgs: i <br />11 08:51 RM <br />