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10/26/2011 WSD 13:41 FAX 402 471 4429 UCC SSCR.BTARY OF 5TATE yy-� Hall k2 �� Form 668 (Y)(c) (Rev. Februery 2004) Area: Seriai Number For SMALL BUSINESS/SELF EMPLOYED AREA #4 � Lien Unit Phone: (800) 913-6050 821882111 � Ax provided by section 6321, 6322, and 6323 of' the internal Revenue Code, we� are giving a notice t6at taxes (inciud�ing �nterest and penalties) have .b�n ass�.ssed agan�st the fopowleg-named taxpayer. We have made a demand for payment of this tiability, bat it remains unpaid. Therefore, there is a lien in favor of the L1nited States on a[I property and rights to property belonging to this taxpayer for the amount of these taxes, aud additiona! peaalties, interest, and casts t6at may accrue. . . Name of Taxpayer GORDON P& ROSEMARY BT,AKF Residence IMPORTANT RELF.ASE lA[FORMATION: For each assessment listed below, unless notice of the lien is reflled by the date given in column (e), this notice shaQ, on the day following swch date, operate as a certificate of release as defined � in IRC 6325(a1. � Tax Period Date of Las�t� D_a�y for Kind of Tax � End9ng Identifjimg Number Assessment .� Refiling �003/004 Departmant of the Treasury - Internal Revenue Service Notice of Federal Tax I.ien 2 0� 10 � 0 2 � 2455 LAMAR AVE GR.AND ISLAND, NE 68803 Use by Recvrdfng vffice Dffi Sac of S�ale John p Gale - lIGC RR 99318T5209-7 Pss; 1 BLAKE GORDON P Filed: 10/26/2011 09:18 AM ; � Unpaid BaWnce of Assessment io4o 12/37./2009 xxx-�-o��3 �o�/ii/2oii� os/io/aoa�. Piace of Filing Register of Deeds Ha11 POBOX 1692 Grand Island, NE 68802-1692 Total I $ This notice was prepared and signed at CHiCAGO, IL the 18th day of October � 2011 1458.03 _ �. �. ;. � ti. i I . 1458.03 I• � �.. i _ , on this, I. P• i . � ;, Signature Title ��` REVENUE OFFICER 24-10-1739 for KAY PONTE � (308) 384-4850 � .(NOTE: Cerdficate of officer authorized by law to take ecknowledgment is not essential to the validity of Notice of Federel Tax lien � � � Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(lfj(c� lRev. 2-20 1 I' Part 1- Kept By R�ordtng Office CA7. NO 60026X !� . ;