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06/22/2011 WED 14:31 FAX 402 471 4429 UCC SECRETARY OF STATE �-�y xall <br />� <br />� Fo� bbs mc�� <br />(Rav. February 2W4� <br />359 <br />�003/003 <br />Department of the Treasury - Internal Revenue Service <br />Natice af Federal Ta�c Lien <br />Area: Serial Number <br />$NIAI,L BIISINrsSS/S�LF �LOYED AREPL #4 <br />Lien Unit Phone: (800) 93.3-6050 792919311 <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are gfiring a notice that taxes (including interest and penalties) <br />have 6�n assessed against the foiCowing-pamed ta�cpayer. 'We have made <br />a demand for payment of tbis Uabil�ty, bat it remains unpaid. Therefore, <br />t6ere rs a lien in favor of the United Stata on afl propeHy and r�giits to <br />property be[ong'mg to this taxpayer for the amount o� these taxes, and <br />additional penalties, interest, and costs that may acc <br />Residence 923 W 1ST ST • <br />GRAND ISLAND, NE 68801-5809 <br />For Optional Use 6y Recording Office <br />IMPORTANT RELEASE 1NFORMATION For each assessment listed b�low, <br />uniess notice of the lien is.refiled by the date given in column (e), this notice shall,. <br />on the day fol{owing such date. operate as a certificate of release as dafined <br />in IRC 6325(a). <br />Tax Period Date of last Day for <br />Kind of Tax Ending Idendfying Number Asseumeet Refi 'Img <br />so�o I12/31/2010� x�-xx-3i�.o I05/23/2011) os/aa/aoai <br />Place of Filing <br />20�.�o4ss� <br />llnp�ud Balance <br />of Assessment <br />477.68 <br />Register of Deeds <br />Hall PO80X 1692 <br />Grand Isl and , NE 68802-1692 <br />Total 1$ 477 . 68 <br />This notice was prepared and signed at ����� IL , on this, <br />the �- 3 th day of J� e 2 011 <br />Signature � Title <br />REVENIIE OFFICER 24-10-1744 <br />for PATRICK J I�LLO (308) 38�-4850 <br />(NOTE: Certificate of ofFicer authorized by law to take acknowledgment is not essentlal to the validity ot Notice of Fedecal T�x Ilen <br />Rev, Rul. 71-486. 1871 - 2 C.B. 409) Fprm 6�8(Y}�C� Ifl&Y• 2-�9Q <br />@,al`t �� K�d#t 6�j►1�01'diu6 Of�i� va�r n�� es�weee+ <br />� <br />