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04/19/2011 TUE 15:38 FAX 402 471 4429 UCC SECRETARY OF STATS ��� Hall <br />� <br />�J Form 668 (Y)(c) <br />(Rev. Febcuary 20041 <br />Area: Serial Number <br />SMALL BUSINESS/SSLF ENiPLOYED AREA #4 ' <br />Lien Unit Phone: {800) 913-6050 772069311 <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that t�es (including interest and penaities) <br />have been assessed against the following-named taxpayer. We have made <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />theee is a lien in favor of the 0nited States on all property and righ�s to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additiona! penalties, interest, and� costs that may accrue. <br />Name of Taxpayer SCOTT & KAREN GALUSHA <br />Residence 31.4 WAINWRIGHT ST � <br />GR.AND ISLAND, NE 68801-8376 <br />For Optional Use by Recording Office <br />Department of the Treasury - Internal Revenue Service 2 Q 110 2 9� S <br />Notice of Federal Tax l,ien <br />IMPORTANT R.EI,EASE INFORMATION Fo� each assessment listed below, <br />unless notice of the lien is refiled by the date give� in column (e), this notice shall, . <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 for <br />Klnd of Tax Ending ideirtNying Num6er Assessment Refiling <br />1040 12/31j2009 XXX-XX-1624 02/07/2011� 03/'09/2021 <br />0 <br />Place af Filing <br />Register of Deeds . <br />Hall POBOX 1692 . <br />Grand Island, NE 68802-1692 <br />�003/005 <br />unpaid Ba[ance <br />of Assessment <br />4919.48 <br />Total �$ 4 919 . 4 8 <br />This notice was p�epared and signed at CHICAGO, IL <br />the 31st day of March 2011 <br />, on this, <br />Signature � Title <br />REVENUE OFFICER 24-10-1720 <br />for DANIFLLE L MUFLL (402) 473-4�75 x2912 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not esse�tial to the vaUdlty of Notice of Federal Tax lie� <br />Rev, Rul. 71-466, 1971 - 2 C.B. 4091 . • • Form 668(�(c) (Rev.2-2004 <br />Part 1- Kept By Recording OFHce CAT. NO 60025X � <br />