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03/02/2011 WSD 15:11 FAX 402 471 4429 UCC SECRETARY OF STATS ��� Hall <br />� <br />� Form 668 (ln(c) <br />(Rev. Fe6ruary 2004) <br />Departme�t of the T�easury - Internal Revenue Service <br />� Notice of Federat Tax Lien <br />Area: � Ssrial Number For Optione <br />SNlALL BUSINfiSS/SBLF SNIPLOYED AREA #4 ' <br />Lien Unit Phone: (800) 829-3903 756002611 <br />AS provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are �ving a notice t[wt taxes (inctuding interest and penalties) <br />have been a$sessed against the foilowing-named taxpayer. We have made <br />a demand for payment of thls liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the llnited States on all property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may aarue. <br />Name of Taxpayer JASON C LAWHORNE _ . <br />Residence 339 1/2 S OAK ST <br />GRANll TSLAND, NE 68801=7839 <br />1MPORTANT RELF.ASE INFORMATION: For each assessment listed below, <br />un{ess notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as a certlficate of release as defi�ed <br />in iRC 6325{a). <br />Tax Per�od Date of Last D�ay for <br />Kind of Tax Ending Identitying Number Assesse�ent Refiling <br />1040 12/31/2004I XXX-XX-0229 IO2/08/2010� 03/09/2020 <br />1040 12/31/2005� XXX-XX-0229 10/05/2009 11/04/2019 <br />Use by Recording Office <br />�hn R Gsls - UCC FTL <br />P9s: 1 <br />C <br />1i 10:52 AM <br />201101697 <br />llnpaid Balance <br />of Assessment <br />4879.84 <br />52787.12 <br />Place of Filing <br />�002/005 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand I NE 688 02-1692 <br />Total �$ 57666.96 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 17th day of February 2011 <br />Signature � Title <br />ACS SBSE 24-00-OOQ8 <br />for MICHAEL W. COX � (800) 829-3903 <br />(NOTE: Certiticate of o�cer authorized by Iaw to take acknowledgment is not esseMial to the vaUdity of Notice af Federal Tax lien � <br />� Rev. Rul. 71-466, 1971 - 2 C.B. 409) <br />p � ' . � � ��� � Form 668(ln(c) (Rev. 2-2004! � <br />CAT. NO 60025X <br />