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05/19/2011 TgU 14:45 <br />Form b68 (Y)Cc) <br />(Rev. February 2004) <br />FAX 402 471 4429 UCC S$CRETARY OF STATF3 �-�-� Hall <br />A�ea: Ser[al Number <br />srrAr,L Bvsnvr�ssls�.t,� �rao�n n�, #� <br />Lien Unit Phone: (800) 913-6050 � 781976811 <br />As provide�l by section 632 t, 6322, and 6323 of the Internal Reveeue <br />Code, we are giving a nodce tbat t�xes (including interest aed penaldes) <br />have been ass�sed against the foitowing-named taxpayer. We Itave made <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the United States on al! property and rights to <br />property betonging to this taxpayer for the amoumt of these tazes, and <br />additional penalties, 6 �terest, an ws t ma y aarue. <br />axpayer <br />Residance 18272 W HUSKER H�JY <br />SHPLTON, NE 68876-9775 <br />For Optional Use by Recording Office <br />N6 See of Slete dehn p 6e{a - UCC FTL <br />9911662021 Pss: � <br />TtlREK flHRK <br />Ftled: O6/19/2011 08:42 RM <br />@looz/oa4 <br />IMPORTANT RELEASE 1NFORMATION For each assessmeM listed below, <br />unless notice of the lien is refilsd by the date given in column te), this notice shall, <br />on the day following such date, operate as a certiticate of release as defined <br />in IRC 6325(a). <br />Tax Period Date of last D�arfor <br />Kind af Tax Ending Identifyim$ �{im�ber Assessment RefilUg <br />2290 07/Ol/201Q 30-0277314 03/J�4/2011 04/13/2021 <br />941 06/30/2009 30-0277314 03/15/2010 04/14/2020 <br />941 09/30/2009 30-0277314 03/15/2010 04/14/2020 <br />941 09/30/2010 30-0277314 03/21/20�.1 04/20/2021 <br />Place of Filing <br />Department of the Treasury - Internal Revenue Service <br />Alotice of Federaf Tax Lien <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Ialand, NE 68802-1692 <br />148.60 <br />558.Q4 <br />848.47 <br />566.97 <br />Total �$ � 2122.08 <br />This notice was prepared and signed at � =L , on this, <br />the 02nd day of May •� 2011 � � � • <br />� <br />Signature <br />for ERIC MARTIN <br />Title <br />REVENUE OFFI�ER <br />(402) 473-46 <br />201103794 <br />Unpaid Balance <br />of Assessment <br />24-].0-1721 <br />(NOTE: Certtflcate of officer authorized by law to• take acknowledgment is r�t sssential to the validity of Nodce of Federal Teuc lien <br />Rev. Ruf. 71-466, 1971 - 2 C.B. 409► Form 668(n(c) (Rev. 2-2004 <br />part 1' K!ept BY Rewrd�8 O�ce CAT. NO 80026X <br />