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11/02/2011 WED 14:50 FAX 402 471 4429 UCC SSCRETARY OF STATE ��� Hall <br />V �7 <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br />�004/004 <br />Department of the Treasury - Internal Revenue Service <br />Notice af Federal Tax Lien <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED ARfiA #4 <br />Lien Unit Phone: (800) 913-6050 823769211 <br />As provided by section 6321, 6322, and b323 of the Internal Revenue <br />Code, we are giving a notice that taxes (inclading interest and penafties) <br />have been .assessed against the following-named taxpayer. We have �nade <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the Ilnited States on all 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 accrue. <br />Name of Taxpayer SHANE F HIGGINS <br />Residence 3 3 3 5 PRIMROSE DR <br />GRAND ISLAND, NE 68801-8762 <br />For Ootional Use by. Recording Office <br />NE Sec of Sta�e Joh� A Gala - U[C FTL <br />9911675$9$-6 P9s: 1 <br />NIGGINS SIiFlNE F : <br />Filed: 11/02/2011 11:05 AM <br />�o�.i����� <br />1MPORTANT RELEASE INfORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date g+ven in calumn (e), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in {RC 6325(a). <br />Tax Period Date of Last Day for <br />Kind of Tax Ending Identifying Number Asseument Refiling <br />(a) (b) (�) � (d) (e) <br />1040 12�31�2007 XXX-XX�-8683 03�14�2011 04�13�2021 <br />1040 12/31/2008 XXX-XX-8683 03/14/2011 04/13/2021 <br />Place of Filing <br />Register of Deeds <br />Ha11 POBOX 1692 <br />. Grand Island, NE 68802-1692 <br />This notice was p�epared and signed at <br />the 25th day of Octaber <br />CHIGAGO, IL <br />2011 <br />tlnpaid Baiance <br />of Assessment <br />378266.49 <br />144996.85 <br />'fota! , $ 523263 .34 <br />, on this; <br />Signature Title <br />�,✓�Lt` REVENUE OFFICER 24-10-1739 <br />for� KA.Y. PONTE. (308) 384-4850 <br />(NOTE: Certificate of officer authoriied by faw to take acknowtedgmeni is not essential to the vaiidity of Notice ot Federal Tax lien <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409{ _ Form b68(Y)(c) (Rev. 2-2004) <br />Part 1-�Kept By Recording Office - CAT. NO 60025X <br />� . `�� <br />