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04/20/2011 WED 15:25 FAX 402 471 4429 UCC SECRETARY OF STATE ~~� 8a11 <br />'�" �• 3592 . . <br />Eorm 668 (Y)(c) <br />(Rev. Fe6ruary 2004) <br />Department of the Tre�sury - InternaF Revenue Service <br />Notice of Federal Ta�c Lien <br />A�ea: � Serial Number For Optional Usa by Recording Office <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 773353311 <br />As provided by section 6321, 6322, and b323 of the Internal Revenue <br />Code, we are giving a notfce that taxes (inclading interest and penaities) <br />� have beee assessed against the foi[owing-named taxpayer. We have made <br />a demanc� for payment of tl�is Iiabil�ry, but it remains unpaid. Therefore, <br />there is a 6en in favor of the linit+�d States on aIt properh► and rignts tQ <br />properiy belonging W this taxpayer far the amamt of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />T�xpayer <br />f�oo9�ooa <br />� s.� <br />99116 <br />REIS J <br />Filed: <br />201103Q�� <br />�Residence 4].45 MANCHBST$R RD <br />GRAND ISLAND, NE 68803 <br />IMPORTANT RELEASE INEORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (ei, this notice shall, <br />on the day foilowing such date, operate �as a certificate of �elease as defined <br />in IRC 63251a). <br />Tax �Period . Date of Last Day for <br />Kind of Tax Ending IdentlfyUng Number Assessment Refiiing <br />1040 �12/31/2Q07� XXX-XX-7247 �02/15/20I0� 03/16/2020 <br />Iinpaid Balance <br />cF Assessment <br />2800.81 <br />Place of Filing <br />Register o£ Deeds <br />Hall POBO� 1692 <br />Grand Island, NE 68802-1692 <br />Total �$ 2 8 0 0. 81 <br />This notice was prepared and signed at � IL <br />the 06th day of April 2011 <br />. <br />, on this, <br />:; <br />�� <br />i <br />1 <br />i. <br />i <br />i <br />Signature ' � Titie i <br />REVENUE OFFICER 24-10-1720 �� <br />for DANIELLE L MUELL (402) 473-4675 x2912 - <br />(NO'fE: Csrtificete of offioer authorized by law•to take actvrowledgment ia rtoresseMial to the valid'tty of Notice of Federal Tax Uen <br />Rev. Rul. 71-4fi6, 1971 - 2 C.B. 4091 � Form 668(n(t) (Rev. 2-20041 � <br />Part 1• Kept By Rscordin8 �� CAT. NO 6�025X F <br />