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Q6/22/2011 9�t'SD 14:31 PAX 402 471 4429 UCC SSCRETARY OF 5TATE -+-�-+ Hall <br />� <br />1 � <br />�oaz�aos <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federai Tax Lien <br />�orm 668 {l�(c) <br />(Re�. February 2004) <br />Area: Serial Number <br />SMALL SIISINESS/SELE' EMPLO'YFs�D RREA #� <br />Lien Unit Phane (800) 913-6050 792919211 <br />As provided by sect�on 632 i; b322, and 6323 of the Internal Revenue <br />Code, we are �g a notice that taxes (includimg interest aad penalties) <br />have 6een assessed against the folluwing-named ta�cpayer. We have made <br />a demand for payment of this tiaabi�ty, but it reawins unpaGd. Tf�er�fore, <br />there is a lien in favor of the 1lnited States on atl property and rights to <br />property beioegfiig to this ta�ayer for the amount of r�ese taxes, and <br />add4tio»al penai�ies, interest, and costs that may accrue. <br />Residence <br />1416 SYLVAN ST <br />GRAND ISLAND, NE 68801-716.1 <br />Office <br />9931684631-9 Pos: 7 . <br />DAR1� JRNELL M <br />Filed: 06/22/2011 09:2b RM <br />�o�1o4sso . . <br />For <br />IMPORTANT REi.F.ASE iN�ORMA'ftON: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e1, this r�otice shall, <br />on the day following such date, operate as a certificate of re(ease as defined <br />in IRC 6325(a}. <br />Tax Pert�t � Date of �Last D�ay for <br />Kind of Tayc Ending ldentgfjrtng Number Auessment Refiling <br />1040 <br />1040 <br />12/31/2007 XXX-XX-9033 <br />12/31/2009 XXX-XX-9033 <br />� <br />Place of Filing <br />tlnpaid Bafance <br />of Assessment <br />03/21/2011I 04/20/2027. <br />02/21/2011� 03/23/2021 <br />Register of Deeda <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Tota1 � $ <br />257.45 <br />� • 2588.24 <br />2845.69 <br />This notice was prepared and signed at �ICAGO, IL <br />, an this, <br />� <br />; <br />�: <br />i <br />;� <br />� <br />the 13th day of June 2011 � <br />. <br />Signature � Title " <br />REVENUE OFFICER . 24-10-1744 <br />for PATRICR J KELLO � (308) 384-4850 <br />(NOTE: Certificate afi officer authorized by law to take acknowledgment is not essentiel to the vaUdfty of Nodce of Federel Tax lien � <br />Rev. Rul. 71-466, 1971 - 2 C.B. 4091 Farm 668(n(c) (Rev. 2-2004) � <br />� Part 1- K�t By Recordtng OERce CAT. NO 60025X ' <br />