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il/22/2011 TUE 15:12 FAX 402 471 4429 UCC SECRETARY OF STATE ��~ Hall <br />� <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Area: Serial Number <br />SMALL BUSINESS/SBLF FMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913-6050 829822711 <br />As provided• by section 632 f, 6322, and 6323 of the Internal Revenae <br />Code, we are giving a notice that taxes (including interest and penalties) <br />have 6een asseued against the following named taxpayer. We have made <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />there is a lien in favor of the l[nited S'tates on all property and rights to <br />property belonging to thls taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that n�ay aarue. � <br />Name of Taxpayer RONALD L BURES <br />Residence 1108 S SYCAMDRE ST <br />GR.AND ISLAND, NE 68801-7961 <br />For <br />NE Sae <br />991 iE <br />��: 1��I s <br />1MPORTANT REL�ASE INFORMATION: For each assessment listed below, <br />� unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as �a certificate of retease as defined <br />in IRC 6325(a). <br />. Tax Period Date of Last Da�r for <br />Kind of Tax Ending Identifying Number Assessment Ref'�ng <br />1040 �12/31/2004� XXX-XX-1069 �08/24/2009� 09/23/2019 <br />Place of Filing <br />Register of Deeds <br />- Hall POBOX 1692 � <br />�,.. Grand�Island� NE 68802-1692 <br />Llnpaid Balance <br />of Assessment <br />�002/002 <br />Use by Recording Office <br />11158.99 <br />Total • �$ 1115 8. 9 9 <br />This notice vvas prepared and signed at �I�GO, IL <br />the .� 15th day of . November - 2011 <br />, <br />, on this, <br />Signature Title � <br />. Z'�'Z�` REVENUE OFFICER . . 2 4-10 -17 3 9 ' <br />for� FCAY �PONTE (308) 384-4850 � � <br />(NOTE: Certificate of officer authorized by lauv to take acknowledgment is not essentiel to the velidityof Notice of Federel Tax lien •.i <br />- Rev. Rul. 71-466, 1971 - 2 C.B. 409! '. �- � • ' Form 668(n(c) (Rev. 2-20 1 <br />Parc 1 - Kept By Recordin8 �� • CAT. NO 60025X i <br />Department of the Treasury - Internal Revenue Service <br />l�lotice of Federal Yax l,ien <br />