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09/2212Q11 THU 14:36 FAX 402 471 4429 UCC SECRI3TARY OF STAT13 -��+� Hall <br />� Form 668 (Y)(c) <br />(Rev. February 2004) <br />�ooa�oo3 <br />Department of the Treasury - Internal Revenue Service <br />Notice � o# Federal Tax Lien <br />Area: . Serial Number <br />SMALL BUSTNESS/SELF SMPLOYED AREA #4 , <br />Lien Unit Phone: (800) 913-6050 S1z853611 <br />As provided by settion 6321, 6322, and 6323 0# the )nternal Revenue <br />Cade, we are givieg a nodce that ta�ces (induding interest and penaltles) <br />have been auessed against the following-named taxpayer. We have made <br />a demand for payment of this tiaNi[ity, but iC remaa�s unpaid. Therefore, <br />there �S a tien in fa�or of the l]nited Stat�s on aq property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may acave. <br />axpayer <br />, a <br />Residence 22Q OXNARD AVE <br />� GR.AND ISLAND, N'F 68801-6782 <br />Fo� <br />YMPORTANT RELFJ#SE INFORMATION For each assessmerrt listed below, <br />unless nutice of the lien is refi{ed by the date given in column (e), this.noti�e shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325fa). <br />� Tax Periad � � Date of Last Day for <br />Kind of Tax Endiag � Identifying N�nnber Assessment Reflliug <br />940 12/31/2004 <br />940 12/31f2007 <br />941 03/31/2005 <br />941 06/30/2405 <br />941 09/30/2005 <br />941 12f31/2005 <br />27-5405920� 08/22/2011 <br />27-5405920 08/22/2Q11 <br />27-54U5920 08/15f2�11 <br />27-5�l05920 08/15/2C�1? <br />27-5405920 08/22/2011 <br />27-5405920 06/15f2011 <br />09/21/2Q27. <br />09/21/2021 <br />09/14/2021 <br />fl9/]4/2021 <br />09j21/2021 <br />09i14/2021 <br />Use bv Recording Office <br />'r S�aee ieffn R Gele - UCC FTL <br />2323-6 P9s: i <br />MURRAV & MflSER, A PpRTN <br />09J22/2011 09:54 AM <br />20�10i44� <br />tlnpaid Balance <br />of Assessment <br />455.84 <br />277.54 <br />9470.46 <br />10189.62 <br />11151.87 <br />9935.39 <br />� <br />� <br />Place of �iling <br />Register of Deeds <br />Ha11 POBOX 1692 <br />Grand Island, NE 68802-1692� <br />Total �$ 41480.72 <br />This notace was prepared and• signed at � �'� ` IL <br />the 07th �ay of Septiember 2011 <br />, <br />, on this, <br />Signature � � Title <br />REVENUE OFFICER 24-10-1720 <br />for DANIELLE L Mi]ELL (402). 473-4675 x291,2- <br />(NOTE: Certificats of officer authorized by faw to take acknowledgment is not essential co the validity of Notice of Federat Tex tien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) , Form 668(n(c) IAev. 2-2004) <br />. Parc 1. - Kepc By Recordins Offlce . CaT.. No soo25x <br />