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03/11/2011 FRI 14:25 FAX 402 471 4429 UCC SSCRBTARY OF STATS ��� Hall <br />Form b68 (Y)(c) <br />iRev. Febtuary 2004) <br />���� <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />�ooz�oo2 <br />Area: Seriai iVumber For Optio�al Use by Recording Office <br />_ ........................ ... .. <br />-SMALL -BUSINESS 3ELF--EMPLO�ED - AREA #2 <br />Lien Unit Phone: (800) 913-6050 760683511 <br />As provided by section 6321, 6322, and 6323 of the lnternal Revenue NE Sec of Skekr �oh� R 6a1• ' UCG i <br />Code, we are givi»g a notice tfiat taxes (including interest and penalties) <br />have been assessed against the following-named taxpayer. We Fwve made <br />a demand for payment of this tiability, bat it remaies anpaid. Therefore, <br />there is a lien in favor of the 0nited States on all praperty and rights to <br />property belonging w this taxpayer for the amount of these taxes, and gg11653116 Pe== <br />additional penalties, interest, and costs that may accrue WRLTERS NpTF#aN J <br />Filad: 03/71/2011 10:t6 RM <br />e of ?axpayer <br />Residence 3 03 8 INDIAN HILL DR <br />LIMA, OH 45806-1357 <br />IMPORTAI�lT RELEASE INFORMATION For each assessment listed below, <br />un4ess notice of the lien is refilsd by the date given in cotumn ie), this notice shall, <br />on the day foUowing such date, operate as a certificate of release as defined <br />in IRC 63251a). - <br />Tax Period Date of Last Da�y for <br />Klnd of Tax Ending Identifying Number Assessment Refiling <br />(a) (b (c) d) (e <br />1040 12/31/2007 XXX-XX-9167 11/O1/2010 12/O1f2020 <br />Ptace of Filing <br />llnpaid Balance <br />of Auessment <br />185401.25 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 58802-1692 <br />Total � $ <br />This �otice was prepared and signed at CHICAGO, IL <br />the 28 day of February 2011 <br />185401.25 <br />, on this, <br />Signatu�e Title <br />��` REVENUE OFFICER 22-11-3739 <br />for GWFNDOLYN BRENNER {419) 224-5134 <br />(NOTE: Certificate of officer authori2ed by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B, 4091 Form 668(Y)(t) fRev. 2-2004 <br />Part 1- Kept S�r Recording Of�ice CAT. NO 60025X <br />i <br />� <br />i <br />� <br />i <br />i <br />