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10/07/2011 FRi 15s02 FAX 402 471 4429 UCC SECRETARY OF STATE -�-�-� 8a11 <br />i' <br />Form 668 t'1n(c) <br />IRev. February 24�4! <br />3 <br />Area: Serial Number <br />SMALL BUSINESS/SLLF EMPLOYED RREA #4 <br />Lien Unit Phone: (800) 829-3903 814845411 <br />As provided by section 6321, b322, and 63Z3 of the Internal Revenue <br />C�le, we are giving a nvdce that taxes (induding �nterest and penalties) <br />have been assessed ag�st the following named taxpayer. We have made <br />a demand for payment of this liability, bat it remains anpaid. Therefore, <br />there is a lien in favor of the llnit�l States on aII prope�ty and rights to <br />propertg beIonging.to this taxpayee for the amount of these taxes, and <br />additional .penalties, interest, and costs that may accrae. <br />e <br />Residence - 314 CHEROKEE AVE <br />GRP�TD ISLAND, NE 68803-3805 <br />For <br />�OD5/005 <br />Off(ce <br />Nfi Sae of Stala .tahn A Gale - UCC FR <br />9911673SSS-1 Pa9: 1 <br />JOHNSON MICHR0. <br />Fited: 10/07/2011 10:28 RPI <br />IMPORTANIT�RELEASE IN�FORMATION: for each assessment listed befow, <br />uNess notice of the lien is refiled by the date givan in column (e), this notice shali, <br />on the day following 'such date, operate as a certificate of release as defined <br />in IRC 6325{a). <br />Tax Period Date of - Last D for <br />Kind of Tax Ending identifying Number Assessment Refl�g <br />1040 �12i3]./2009� XXX-XX-8816 �05/3Q/2011� 06/29/2021 <br />Place of Filing <br />Ilapaid BaWncs <br />of Assessment <br />12483.80 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total �$ I2483.80 <br />This notice was prepared and signed at CHICAGO, IL <br />the 15th day of September 2011 <br />, <br />, on this, <br />Signature � ,� Title <br />�iCS S$SE 2.4- � <br />for MICHAEL W.� COX (800� 829-3903 ' <br />(NaTE: Certiticate of officer authorized by •law to teke ecknowiedgment is not esssntial ta the validlty of Notice of Federal Tex fien <br />Rev. Rul. 71-456, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-20041 <br />Part 1- Kept By Recording Offlce CAT. NO 60026X ` �1 . <br />1�✓ <br />Department of the Treasury - Internal Revenue Service � 011 U 7 5 2 2 <br />N o t i c e o f F e d e r a! T a x L i e n <br />� <br />