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05/06/2011 FRI 13:46 F.Ax 402 471 4�29 UCC SECRETARY OF STA'TE -�-+-� Hall <br />3 <br />�orm 668 (Y)(c) <br />(Rev. February 2004) <br />Fcr Oadonat Use bv RecoMinu Office <br />Department of the T�easury - intemal Revenue Service <br />Notice of Federaf Tax I.ien 2 0110 3 4 91 <br />Area: Serial Number • ' <br />SMALL BIISINESS/SBLF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 777513911 <br />As provided by sec�Tion 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are �vittg a notice that taxes (including interest and pena[t�es) <br />have been asse�s�d against the following named taxpayer. We I�ive made <br />a demand for payment of t6�s liability, but it remains unpaid. Trerefore, <br />there �S a[�en in favor of the �llnited Stat�s on a11 property and rights to <br />Pr�i'tY �b�SM� �� �palrer for the amount of t�ae taxe.s, and <br />addit�onai penaldes, interest, and c�ost�s that may acuue. � <br />Residence 4152 HARTFORD ST <br />GRA1�iD ISLAl�Tp, NE 68803-2255 <br />iMPORTANT REI.�ASE INFORMATION: For each assessment list� below, <br />unless �notice of the lien is �efiled by the date given in column (e), this notice shall, � <br />on the day following such date, aperate as a certi#icate pf release as deffned <br />in IRC B325(a). <br />Tax Period Date of I,ast D�a for <br />Kind of Tax � Ending Identdying Number Ass�ssroent Re�ling <br />2040 '12/31j2004� XXX-XX-0755 �04/04/2011�.05/,04/2021 <br />Place of �iling <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Isla nd, NE 68802-1692 <br />�ioo,zloo3 <br />1 11:05 RM <br />llnpaid Balance <br />of Assessment <br />4162.83 <br />Total � $ 4162 . 83 <br />This notice v+Fas prepared and signed at � � TL - , on this, <br />the 18th day of April 2011 _ . . _� <br />, � <br />Signature ��� Title <br />REVENIIE OFFICER 24-10.-172Q <br />for DANIELLE L MOELL (402j 473-4675 x2912 <br />(A10TE: Certificate af oificer authorized by law to take acknowledgrtient is not esserrtial �o tfie validtty of Notfce of Federal Tax lien <br />. Rev. Rul. 71-46&, 1971 - 2 C.6. 408y • .. . . <br />� Form 668(ln(c) (Rev. 2-Z004 <br />. Part 1- Kept B�r Record6�g Oftice CAT. NO 60026X <br />i <br />