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05/05/2011 TgU 14:17 FAX 402 471 4429 UCC SECRBTARY OF STATE -�-�y sall <br />O� <br />Form 668 (lf)(c) <br />' (Rev. February 2004) <br />E� <br />�003/005 <br />Department of the Treasury - lnternal Revenue Service <br />Notice of Federal Tax Lien � <br />Area:. Serial Number <br />SMAI�L BIISINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 779480111 <br />As provid� tiy sectian 6321, 632Z, and 6323 of the Internal Revenae <br />Code, we are giving a notice that taxes (including �terest and penaldes) <br />have 6een a�essed against the followmg named taxpayer. We have made <br />a de�nd for �payment of tfds lia6ility, but it remains impaid. Therefore, <br />there is a tien in favor of the llnited States on all propeny and rights to <br />property b�llongTmg to this taxpayer for the amount of these taues, and <br />additional penalties, interest, and ca�sst,t that may aarue. <br />axpayer <br />Residence <br />1619 S LINCOLN AVE APT 3 <br />GRAND ISLAND, NE 68801-0714 <br />�Q11034�� <br />For Oational Use bv Hecording Office <br />IMPORTANT RELEASE 1NFORMATION For each assessment listed below, <br />unless notica of the lien is refiled by the date given in column (e}, this notice shall, <br />on the day foliowing such date, operate as a cenificate of release as defined <br />in IRC 6325{a). <br />Taac Period � Date of Last D_a�y for <br />Kind of Tax Ending IdeefY(ying Number Assessment . Refiling <br />(a) (b) (�) d) (e <br />1040 12/31/2008 XXX-XX-0795 04/15/2009 05/15/2019 <br />1040 12/31/2008 XXX-XX-0795 04/27/2009 05/27/2019 <br />1040 12/31/2008 XXX-XX-0795 OS/23/2010 d9/22/2020 <br />Piace of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />42185.54 <br />Total I�$ 42185.54 <br />This notice was prepare� and signed at CHICAGO, IL <br />the 22nd day of April 2011 <br />tJnpaid Balance <br />of Assessment <br />, on this, <br />Signature �. Title <br />REVENUE OFFICER 24-10-1720 <br />for DANIELLE L M[TFLL (402) 473-4675 x2912 <br />(N07'E: •Certitfcate of of6cer authorized by law to take acknowledgment is not essential to the uplidity of. Notice of Federal Tex Jten <br />Rev. Rui. 71-488, 1971 - 2 C.B. 409) • • <br />� Part t- K�t 8�r Recordin8 ��e . Fnrm 668(n(c) IRev. 2-200 <br />CAT. NO 60025 <br />\ <br />