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Q7/2Q/2Q11 WED 15:3Q <br />� <br />O <br />Form 668 tY)(c) <br />lRev. February 2004) <br />FAX 402 47]. 4429 UCC S�CR&TARY OF STAT& �-�-� 8a11 <br />Department of the Treasury - Internai Revenue Service <br />Notice of Federal Tax Lien <br />Area: Seria) Number <br />sr�, susn�essiss� �LO�n �, #� <br />Lien Unit Phone: (800� 913-6050 798504011 <br />As provided by section 6321, 6322, and 6323 of the laternal Revenue <br />Code, we are giving a notice that taxes {inc[uding interest and penalties) <br />have been assessed agaiest the followia8c-named taxpayer. We .have made <br />a demand �or payment of this liabi[�ty, bat it remains anpaid. Therefore, <br />there is a lien im favor of t6e United States on alt property and right� to <br />proper�y �belonging to this taxpayer for the amaunt of these taxes, and <br />additional penalties, interest, and costs that may aurue. <br />ame of <br />Residence 920 S LOCIIST ST .� <br />GRAND ISLAND., NE 68801-6768 <br />IMPORTANT RELF�SE INFORMATION For eeeh assessment listed below, <br />aNess notice of the lien is refited by the date given in column (e), this notice shall, <br />on .the day following such date; operate as a certificate of releasa as defined <br />in IRC 6325(a). <br />Tax� Period Date o� � Las� Day for <br />Kind �of Tax Ending IdentiEj►ing Number Assessmeet Refi�ng <br />1040. 12j31/2002 XXX-XX-8643 08/15/2005 09/14/2015 <br />1040 12/31/2003 XXX-XX-8643 10/27/2008 11i26i2018 <br />1040 12/31/2005 XXX-XX-$643 11/16/2009 12/16/2019 <br />1040 12/3I/2006 X�X-XX-8643 11/16/2Q09 12/16/2019 <br />1040 12/37./2007 XXX-XX-8643 03/14/2011 04/13/2021 <br />�QQ3/005 <br />R WM <br />: 07/20/2011 10:23 HM1 <br />20�.105347 <br />Unpaid Balance <br />of Assessment <br />18124.23 <br />46659.84 <br />15879.59 <br />6864.24 <br />2596.72 <br />d <br />Place of Filing <br />Register of Deeds <br />Hall POBOX I692 <br />Grand I�land, NE 68802-1692 <br />Total ($ 90124.62 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 06th day of July 2011 <br />, <br />Signature � t � Title <br />REVENLTE OFFICER 24-10-1739 <br />for KA.Y PONTE (308) 384-�4850 � <br />(NOTE: Certiflcate of officer euthortzad by {aw to take acknowledgmern is not es�ential to the validity of Notice of Federal Tau lien . <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) ` � <br />Pa�'t t- Kept By Record6t8 O�tice Form 668(lf)(c) lRev. 2-2004! / <br />r.oT n►n ann�FV �' <br />4 <br />For Ootional Use bv Recording Office <br />