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02/11/2011 FRI 15:06 <br />�� <br />FAX 402 471 4429 UCC SSCRETARY OF 5TATS ��� Hall <br />Form d68 (Yxc) <br />(Rev. February 2004) <br />Department of the Treasury - Internal Revenue Service 2� 110118 8 <br />Kotice of Fede�ra! Tax Lien <br />Area: Serial Number � ' <br />SMALL EIISINP�SSfSELF BMPLOYED AREA #� <br />Lien Unit Phone: (800) 913-6050 7488135Z1 � <br />As provided by sect�n 6321, 6322, and 6323 of the internai Revenae ; <br />Code, we are giving a noticc that taxes {including interest and penalties) <br />have been assessed against the follawing-named ta�qwyer. We Mave �de <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the United States on all property and rigfits to <br />property belonging to th�s taxpayer for the amount of these tax�, and <br />additionai penalties, interest, and costs that may aurue. <br />For <br />NE Sae of Sla1Q Jopn N 6�1a - UCC iTL <br />9911651018-4 Pgs: i <br />BUSCHER CONEL J <br />Filed: 02/11/2011 01:02 PM <br />�004/005 <br />Residence 1201 ALLEN DR APT 142 <br />GR7�7D ISLAND, NE 68803-3333 <br />IMFORTANT RELEASE iNFQRMATION: For each assessment listed below, <br />unless notice of the tien is refited by the date given in column {e}, this notice shall, <br />on the day following such date,. operate as a certif;cate of release as defined ' <br />in IF�C' 6325{a). � <br />Tax Period � Date of Last Day for <br />Kind of Tax Ending identif�ring Number Assessment ReRling <br />1040 �12/31/2009( XXX-XX-9802.�].1/22/2010� 12/22/2�20 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 • <br />unpaid Balance <br />of Asseument <br />933.71 <br />Totai �$ 9 3 3. 71 <br />This notice was prepared and signed at CHICAGO, IL � <br />the 28th day of January 2011 <br />, <br />, on this, <br />Signature ��� Title <br />ACS W&I . 14-00-0000 <br />for PAMELA J ROGERS (800) 829-7650 <br />(N07'E: Certificate of officer authorized by law to take acknowledgment is not essential to the validity ot Notice of. Federal Tax lie� <br />Rev. Rul. 71-466, 1971 - 2 C,B. 409i Form 668(1()(c) lRev. 2-20041 <br />Parc 1. - Kept By RewrdiuS �� CAT. NO 60025X <br />�.�/ ± ` � <br />