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Q6/Ql/2Q11 wSD 15:13 FAX 402 471 4429 UCC SECRETARY OF STATE -�-�-� 8a11 <br />F� �s mc�� <br />tRev. Febr�ary 2004) <br />Department�of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial IVumber <br />SMALL BU3INESS/3ELF FMPLOYED AREA �4 <br />Lien Unit Phone {800) 913-6050 785020111 <br />As provided by section 632f, 6322, and 6323 of the Internal Revenue <br />Code, we are g�ving a notice that tax� (3ncluding �nterest and penalties) <br />have been asseued against the following nam� taxpayer. We have made <br />a demand for payment of th� liab'�t'irty, but �t remains unpaid. Therefore, <br />there �S a�ien in favor of the llnited States on all property and ri�ts to <br />property 6elonging to t6is taxpayer for �he amawt of these tax�s, and <br />additional penalties, Interest, and costs that may accrue. <br />Taxpayer <br />Residence 923 T�d 1ST ST. <br />. GRAND ISL,AND, NE 6$801-5809 <br />For <br />�003/003 <br />; <br />i <br />201104173 <br />Usa bY Recording Office ; <br />IMPORTANT REbEASE INFORMATIONs For each assassment listed 6elvw, <br />unfess notice of the fien is re�led by the date gin+en in culumn (e}, this notice ahall, <br />on the day following such date, operate as a cartificate of release as defined <br />in IRC 6325(a). <br />Tax Period Date of Last Day for <br />Kind .of Ta�c Ending ldent�f�ri�►g Nnmber Ass�sment RefilinE <br />1�40 <br />104U <br />1040 <br />1040 <br />1040 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />llnpaid Balance <br />of �►ssessment <br />Total � $ <br />5896.66 <br />3244.29 <br />2240.79 <br />2644.89 <br />2222.05 <br />1624$.68 <br />This notice was prepared and signed at � IL <br />the 11th day of May 2011 <br />, on this, <br />; <br />E <br />Signature Title <br />. T��` REVENUE OFFICER 24-10-174 <br />for PATRICR J ICELLOGG (308) 384-4850 <br />(NOTE: Certiiicate of officer authorized by lew to take acknowledgment is not essentiat to the validity of Nettce of Federel Tax liesi . . <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409! Form 668(ln(c) {Rev. 2-20041 <br />Part 1- ICept By Recording Olflce CAT. NO 60026X <br />12/31/2003 XXX-XX-3110 04/18/2011 <br />12/31/2006 XXX-XX-3110 Q4/25f2011 <br />12/31/2007 XXX-XX-3110 04/25/2011 <br />12/31/200$ XXX-XX-3110 0�4/04/2011 <br />1�/31/2009 XXX-XX-3110 04./04/2011 <br />05/18/2021 <br />05/25/2Q21 <br />05/25/2021 <br />05/04/2021 <br />05/04/2021 <br />