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02/11/2011 FRI 15:05 FAX 402 471 4429 UCC SBCRETARY OF STATE ��� Hall <br />c� <br />Form 668 (Y)(c) <br />IRev. February 2004) <br />Department of the Treasury - Inte�nal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Number For opt�onei use <br />SMAT,L BUSINSSS/SFsLF �MPLOYED AREA #4 <br />Lien Unit Phone: (800) '829.-3903 748522111 <br />As provided by section 632 t, 6322, and 6323 of the Internai Revenue <br />Code, we are giving a notice that taxes (inctuding interest and penalties) <br />iwve been auessed against the foflovring�narned ta�ayer. We have made <br />a demand for payment of this liabillty, 6at it remains unpaid. Therefore, <br />there is a lien in favor� of the united States oa all property and rights w <br />property belongieg to this taxpayer for the amount o� these taxes, and <br />additiona[ penatties, interest, and costs t6at may accrue. <br />Name of Taxpayer DAVID G GRIMES <br />Residence 3111 COLLPGTs ST <br />GRAND ISLAND�, NE 68803-1709 <br />fMPORTANT RELEASE 1NFORMATION: For each assessment Iisted below, <br />unless notioe of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in 1RC 6325(a). � <br />N[ Sae of <br />9931651 <br />6RIME5 D <br />Filed: 0 <br />11 01:02 PM <br />Tax Period . Date of Last Day for <br />Kind of Tax Ending Identifying i�lumber Assessment Refiling <br />(a) (b) c) d) (e) <br />1040 12/31/2002 XXX-XX-g088 10/24/2005 11/23/2015 <br />1040 12/3I/2003 XXX-XX-9088 11/03/2008 12/03/2018 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Gr and Island, NE 68802-1692 <br />4784.42 <br />13853.95 <br />Total �$ 18638.37 <br />This notice was prepared and signed at CHICAGO, IL <br />the 28th day of January . 2011 <br />, <br />�003/005 <br />2011011�7 <br />by Recording Office <br />�ae .l�tin N 6a1• . UCC FTL . <br />ilnpaid Balance <br />of Assessment <br />, on this, <br />Signature Tiile � <br />��` ACS SBSP 24-00-0008 <br />for MICHAEL W. COX (800) 829-3903 <br />(NOTE: Certificate of officer authorized by law to take aclu�owledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev: Rul. 71-466, 1971 - 2 C.B. 409) Form 668(n(c) (Rev. 2-2004) <br />� Part t- K�t By Recording Office CA7. NO 60025X <br />• . f� � .. <br />