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04/20l2011 6dHD 15:25 FAx 402 4i1 A429 UCC SSCRETARY OF STATB -�-�y Hall <br />� <br />� Form 668 (Y)(c) <br />IRav. Febtuary 2004) <br />Depa�tment of the Treasury -{nternal Revenue Service <br />Notice of �ederal Tax Lien <br />Area: Serial Number <br />SMALL BIISINESS/3ELF EMPLOY$b AREA #4 <br />Lien Unit Phone: i800) 913-6050 - 773328611 <br />As provided by section 6321, 6322, and 6323 af the Internal Revenue <br />Code, we are giving a notice that taxes (inclading interest and pena{ties) <br />have b�en assessed agatnst the following-nam� taxpayer. We have made <br />a demand for payment of this liabifity, but it remains unpaid. Therefore, <br />there is a lien in favor of the linited Stat�s on alf property and riShts to <br />property be[onging to this taxgayer for the amount af these taxes, and <br />additiona[ penalties, interest, and costs that may accrue. <br />Name of Taxoaver JASON R VEFDER � <br />Residence 13 5 A RD <br />� GRAND ISLAND, NE 68801-0316 <br />For OPtional Use by Recording Office <br />NB Sec at 5!a!e �ohn A Gale - IItC F?L <br />991i6595�5-7 Pss: 1 <br />vEEa�t aasora s <br />Flled: �!4/20/2011 02:32 PM <br />IMPORTANT RELEASE INFORMATII?N For each�assessmerrt Usted below, <br />un{ess notice of the lien is reflled by the date given in colum� (e), this notiae shali, <br />on the day following such date, operate as a certificete of retease as defined <br />in IRC 6325{a). <br />Tax Period Date of Last Day for <br />Kind of Ta�c Eading ldent�� Numher Assessment Refi�inS <br />201103040 <br />1040 12/31/2007 XXX-XX-7116 03/21/2�011, Q4/20/2021 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, N'E 68802-1692 <br />Place of Fiting <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the d6th day of April 2011 <br />r <br />Signature � � � Title . <br />REVENIIE OFFICER 24-10-1720 <br />for DANIELLE L MOELL (402) �473-4675 x292Z , <br />(NOTE: Ce�tificate of offiaer autho�ized by law to take acknowledgment is not essentiel to tha validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 4091 Form 668(n(c) IRev. 2-2004) <br />Part i- Kept By Ite�cordfmg OERce CAT. NO 6aU25x '.. <br />llepaid Balance <br />of Assessment <br />�ooz�ooe <br />7167.72 <br />Tota) �$ 7167.72 <br />