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05/25/2011 WED 14:25 FAX 402 471 4429 UCC SECRETAitY OF STATE -�yy 8a11 <br />t <br />Form 668 (lntc) <br />(Rav. February 2004) <br />�Iooa�ooz <br />592 <br />Department of the Treasury - lnternal Revenus Service <br />Notice of Federal Tax Iaen 2 0110 3 9 4� <br />Area; Serial Number <br />3MALL BIISINESS/SFs'LF TMPLOXEA AREA $�4 <br />Lien Unit Phone: (800) 829-3903 � 786490211 <br />As provided 6y settfon 63Z1, 632Z, and 6323 of the Interna[ Revenue <br />Code, we are giving a notice that taxes (including interest and penahies) <br />have been assessed against the following-named taxpayer. We have made <br />a demand for payment of this liability, bat it remains unpaid. Therefore, <br />there is a lien in favor of the iliuited States on aD pr.operty and rights to <br />property belonging to triis taxpayer for the amwmt of these taxes, and <br />add�tional penalties, interest, and costs that may aurue. <br />Name of Taxpayer BETHAl3Y S ROZENDAL <br />Residence 612 W 16TH ST <br />C�RAND ISLAND, NS 68801-3514 <br />For Optional Use bY Reco�ding Of�ice <br />_ " "., rn <br />IMPORTANT RELEASE INFORMATIQN: For each assessment tistad below, <br />unless notice of the�lien is refiled by the date given in column (e}, this notice shall, <br />on the day � following such date, operate es a certificate of release as defined <br />in IRC 6325(a)• <br />Tax Period Date of Last Day for <br />Kind of Ta�c � Ending Ideatifjring Nnmber Assessment ReBling <br />1.040 112/31/2006� XXX-XX-9298 �08/31/2009� 09/30/2019 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692� <br />Grand Island, NE 68802-1692 <br />Total � $ <br />This notice was prepared and signed at CHTCAGO, IL <br />the 17th day of May 2011 <br />13�609 . 80 <br />; <br />13609.80 4 <br />i <br />� <br />�. <br />_ , on this, � � <br />Signature � Title <br />ACS SBSE 24-00-OQO <br />for MICHAEL W. COX (800) 829-3903 <br />(NOTE: Certificete of officer authorized by law to teke acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466. 1971 - 2 C.S. 409) Form 668(1�(c) (Rev. 2 <br />�dKt # � iC4Dt $Y ReFOrdio6 OfHce ran� �,� �artnoav <br />llnpaid Balance <br />oF Auessment <br />