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05119/201 THU 14:45 <br /> � <br />�urm 668 tlntc) <br />tRev. February 20041 <br />FAx 402 471 4429 UCC SSCRBTARY OF 5TATE -�-�-� Hall <br />I�oo4�ooa <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Numbar <br />SMALL BUSIN.PsS3/SELF II►�LOYSD AREA #4 <br />Lien Unit Phone: (800) 829-3903 782338511 � <br />As provided by secdon 6321, 6322, and 6323 of the liateernal Revenue <br />Code, we are giMlmg a notice rf�at taxes (including �tere.st and penalties) <br />have been assessed aga�nst the following-named taxpayer. We 6ave m�de <br />a demand for payment of this liability, but it re�nains unpa�d. Therefcre, <br />there is a lien in favor of the Untted States on ap property and' rig�ts to <br />propeny belonging w this taxpayer fa►r t�►e amount of these taxe�, and <br />additional penafties, interest, and costs th�t may accrae. <br />Residence 2120 WILLIAM ST ' <br />GRAND ISLAND, NE 68801-7427 <br />For Oationel Use <br />lMPORTANT RELEASE 1NFORMATION: For each assessment listed I�low, <br />unless notice of the lisn is refiled by the date �iven in column (e), this noti�e shaU, <br />on the day fo{lowing such date, operate as a certiftcate of release as defin�d <br />in IRC 63251a). � <br />Ta�c Period Date of Last D for <br />Kind of Tax � Ending Identity�ng Number Assessme�rt Refi�g <br />1040 �12/31/2006� XXX-XX-6533 <br />Place of Fili�g <br />201iO3796 <br />Uepaid Balance <br />of Assessment <br />12/27/2010� d1%26/2021 <br />Regis�er of Deeds <br />Hal1.POBOX 1692• � <br />Grand Island, NE 68802- <br />Total � $ <br />6800.77 <br />6800.77 <br />This �otice was prepared and signed at <br />the . 0 3 rd day of May <br />CHICAGO, SL <br />a.��.�. <br />, on this, <br />Signature � Title 24-00-4008 <br />. � ACS SBSE <br />for MICHAEL W. COX� (800) 829-3903 <br />� (NOTE: Gertiticate of officer authorized by law to take acknowlsdgment is not essential to the vatidiry of Aiotice of Federal Tax Ifan <br />Rev. Rul. 79-466. 1971 - 2 C.B. 409) Farm 668(n(t) IRev. 2-20041 <br />parc t- tCepc sr �or�ns o�ice ca�r NO 6002bX �'� <br />i. <br />�, <br />i <br />