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10/25/2p11 TUE 14:43 FAX 402 471 4429 UCC SECRETARY Og STATE y-+-+ Hall <br />�1 <br />' <br />Form 668 (Y)(c) <br />IRev. February 2004) <br />IMPORTANT R.ELF.ASE INFORMATION For each assessment fisted below, ' <br />unless notice of the Ilen is refiled by the date given in column (e?. this notice shal�, <br />on the day following such date, operate as a certificate of release as defined <br />in� IRC fi325(a). � <br />Tax Period Date of Last Day for <br />Kind of Tax Ending Identifying Number Assessment Refiling <br />Department of the Treasury - Internal Revenue Senrice <br />Notice of � Federal Tax I.ien <br />�oozloa3 <br />� <br />209.10'799�. <br />i <br />Use bv Recordiny Office � <br />Area: Serial Number For <br />SMALL SUSINESS/SELF EMPLOYED AREA #1 <br />Lien Unit Phpne: (6 913-6050 .• � �� 8208337Y1 <br />As provided by section 632 t, 6322, and 6323 of the lnternal Revenue <br />Code, we are giving a notice that taxes (including interest and p+�nalties) <br />have been assessed against the following-named taxpayer. We have made <br />� a demand for payment'of this liability, but it remains unpa➢d. Therefore, <br />there is a iien in favor of the tlnited SWtes on aIl property and righu to <br />property belonging �to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer <br />Residence 4142 BUCKINGHAM DR <br />GRAND I$LAND, NE 68803 <br />Nfi So� af 5la�e Jehn q Gale - UCC ,fTl. <br />9911675080-3 Pge: � <br />MILLER TONY <br />Filed: 10/2512011 08:43 AM <br />Unpaid Balance <br />of Assessment <br />Zo4o I12/31j2009 �x-xx-a6oa �ii/is/aolol i2/i5/zo2o <br />1040 12/31/2010 XXX-XX-2602 OS/30/ZO11 06/'29/2021 <br />Place of Filing <br />Register of Deeds <br />Ha11 POBOX 1692 <br />Grand Isl.and, NE &8802-1692 <br />Total � $ <br />24814.12 <br />1375.99 <br />26190 .1.1 <br />This notice was prepared and signed at �TCAGO, IL , on this, <br />the 13th day.of October 2011 <br />, <br />Signature �� Title <br />CASF PROC MGR 21-00-0018 <br />for KAREN ESPOSITO (866� 611-6191 <br />(NOTEs Certificate of officer authorizsd by law to take acknowledgment is not essentfal to the validity Af Notice of Federel Tax lien <br />Rev. Rul. 71-468, 1971 - 2 C.B. 409) Form 668(Y)(t) (Rev. 2-200 <br />Part 1- Kept By Recordipg Office CAT. NO 60025X <br />