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05/20l2011 FRi 14:52 FP,7L 402 471 4429 UCC SECRETARY OF STATE -►-+-� Ha11 <br />�� <br />Farm 668 {l��c) <br />(Rev. February 2004) <br />592 <br />Department of the Treasury - Intemal R�venue Service <br />Notice of Federal Tax l.ien 2 0110 3��'� <br />Area: Serial Numbe� <br />SMA]'�L BIISINESSiSELF EMPLOYED ARTA �4 , <br />Lien Unit Phone: t800) 913-6050 780679011 � <br />As provided by sect0on b321, 6322, and 6323 of the Internal Revenue ', <br />Code, we are giving a not�ce that taxes (inciudgng fi�terest and penatt��s) <br />have been assessed aga�ns� the following-named taxpayer. We have made <br />a demand" for payment of th�s liabl��lity, but it remains unpaid. Therefore, <br />there is a Iien in favor of r�he tlnited States on all property and righCs to <br />property belonging to this t�aacpayer for the arnoudt of these taxes, and <br />additional pena[ties, interest, and costs that may aarae. <br />12�1 W OKLAHOMA AVE <br />, a <br />Residence 1221 W ORLAHOMA AVE <br />GRANll ZSLAND, NE 68801-6652 <br />0 <br />ISLAND <br />Filed: <br />IMFORTANT RELE�SE MFORMA7'(ON: For each assessmerrt listed betow, <br />unless notiae of the lien is refited by the date glven in column {e), this notica sha11, <br />on the day following such date, operate es a certfficate of release as deflnad <br />in (RC 6325(al. <br />T,ax Period Date of i.ast Da�y for <br />Kind of Tax Ending ldeatityfing Number Assessment Re�lling <br />1120 <br />940 <br />941 <br />941 <br />941 <br />941 <br />941 <br />941 <br />941 <br />12/31/2009 <br />12/31/2009 <br />03/31/2009 <br />06/30/2049 <br />09/30/20Q9 <br />12/31/2009 <br />03/31/2010 <br />06j34/2010 <br />12/31/2010 <br />47-0200945 <br />47-0200945 <br />47-0200945 <br />47-0200945 <br />47-0200945 <br />47-0200945 <br />47-02�0945 <br />47-0200945 <br />47-0200945 <br />Ol/31/2011 <br />1]./08/2010 <br />Z1/08/2010 <br />11/Q8/2010 <br />iilos/aoio <br />11f08/2010 <br />11/08/2010 <br />11/08/2010 <br />03/21/2011 <br />03/02/2021 <br />12/08f2020 <br />12/Q$f2020 <br />12i08/202a <br />12/OS/2020 <br />12/08/2020 <br />12/08/2020 <br />12/08/2020 <br />04/20f2021 <br />For Oational Use bv Recordina Office <br />�J004/004 <br />Unpaid Ba[ance <br />of AssessmenC <br />2670.00 <br />76.44 <br />9372.58 <br />13681.37 <br />9403.65 <br />8125.37 <br />7184.75 <br />6543.41 <br />2107.45 <br />� <br />� <br />� <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Is].and, NS 68802-1692 <br />Total� I$ 59165.02 � <br />This notice was prepared and sign� at CHICAGO, IL , on this, <br />the 2 •� th day of April 2011 <br />, <br />Signature � �� Titte <br />REVENUE OFFTCER 2�k--10-1739 <br />for KAY PONTE (308) 384-4850 <br />(NOTE: Certificate of o�cer euthorized by law to take acknowledgment is not essendel to the vattdtty of Notice of Federai Tex lien <br />Rev. Ruf. 77-466, 1971 - 2 C.S. 409) Form 668(1�(t) (Rev. 2-2004! � <br />Part 1- K�,c By Recordtng O�ice CAT. Ng 6Q025X <br />�' <br />1 <br />i. <br />i <br />;� <br />, <br />� <br />