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il/29/2011 TUE 15:21 FAX 402 471 4429 UCC SECRETARY OF STATE �-�-� 8a11 <br />�003/004 <br />C� 3592 <br />�" � Department of the Treasury - Interr►al Revenue Service <br />Form 668 (Y)(�) 2 0110 8 9 5 3 <br />(Rev. February 2004) Notice of Federal Tau Lien <br />Area: Seriat Number Fo• ^�*��nAi I IcR hv Recording Office , <br />SMALL BUSTNESS/SELF EMPLOYED AREA #4 <br />Lisn Unit Phone: i800) 913-6050 830916511 <br />As provided 6y section 6321, 6322, and 6323 of the Internal Revenae <br />Code, we are giving a notice that taxes (including interest and penatt�es) <br />have been assessed against the following-named taxpayer. We have made <br />a demand for payment of this Iiability, 6ut k remains unpaid. Therefore, <br />there is a lien in favor of the United States on alt property and rights to <br />property be[onging to this taxpayer for the amount of these taxes, and <br />additianal penalties, interest, and costs that may accrue. <br />Name of Taxpayer RONALD L& CINDY L BUR.ES <br />Residence 1108 S SYCAMORE ST <br />GRAND ISLANll, NE 68801-?961 <br />1MPORTANT RELEASE 1NFORMATION: For each asaessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this notice shail, <br />on the day fo{lowing such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />NE Sea oT Staie John A 6ale - UCC FTL <br />Tax Period Date of , Last Da�r for <br />Kind of Tax £nding Ideetifying l�iumber Assessment Refiimg <br />1040 12/31/20�.0 XXX-XX-1069 �05/30/2011� 0&/29/2021 <br />Place of Fifing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total �$ 4405.87 <br />This notice was prepared and signed at CHI•CAGO, IL <br />the 18th day of November 2011 <br />. � <br />, on this, <br />Signature � Title <br />• REVENUE OF�'TCER• 24-10-1739 <br />for. KAY PONTE� � . � (308) 384-4850. <br />(NOTE: Certificate of officer �uthorfzed 6y law to take acknowledgm�nt is not esesntial to tha validity bf Notice ot Federal'Tex lien <br />Rev. Rul. 71-466, •1971 - 2 C.B. 4091 • ' ' � � Form 668(Yj(t� IRev. 2�2004) <br />. . Part 1- Kept By Rewrding Office - CAT. NO 6002bX <br />4405.87 <br />lJnpaid Balance <br />of Assessment <br />.� �- <br />