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12/12/2011 MON 15:01 FAx 402 471 4429 UCC SECRETARY OF STATE �-�y Aall <br />� , .- <br />Form 668 (Y)(c) <br />(Rev. Februery 2004) <br />�005/006 <br />Department of the Treasury - Internal Revenue Service <br />lNotice of Federal7'�x i.ien 2 O 110 9 311 <br />Area: � Serial Number <br />�MALL BUSINESS/SELF fiMPLOYID AREA #4 <br />Lien Unit Phone: (800) 913-6a50 833529511 <br />As provBded by section 6321, 6322, and 6323 of the Internal tteve�au� <br />Code, we are giviing a notice that taues (including inter�st and penalties� <br />have been assessed against the following named taxpayer. We have made <br />a demand for payment of this liabil�ty, but it remains unpaid. Therefore, <br />there is a Uen in favor of the L�nited States on all �sropert�r and rights' to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additioraal penalties, interest, and costs that may accrue. <br />Name of Taxnaver CHART W p�'RTrC <br />Residence p0 BOX 424 <br />WOOD RIVER, NE 68883-0424 <br />Fw <br />99116 <br />PpRKS <br />Filsd: <br />IMPORTANT RELEASE 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 release as defined <br />in IRC 6325(a). � <br />Tax Period Date of Last Da��y for <br />LCind of Tax Ending Identfifying Number Assessment Refiling • <br />104 0 <br />1040 <br />io�o <br />1040 <br />1040 <br />1040 <br />1040 <br />Place of Filing <br />12/31/2004 <br />l2/31/2005 <br />12/31/2006 <br />12/31/2007 <br />12/31/2008 <br />12/31/2009 <br />12/31/2010 <br />XXX-XX-4107 <br />XXX-XX-4107 <br />XXX-XX-4107 <br />XXX-XX-4107 <br />XXX-XX-4107 <br />XXX-XX-4107 <br />XXX-XX-4107 <br />08/30/2010 <br />03/28/2011 <br />04/04/2011 <br />03/28/2011 <br />12/28/2010 <br />07/26�2010 <br />05/23/2011 <br />15756.6� <br />4270.79 <br />1512.98 <br />1R5A . 2�4 <br />589.21 <br />318.72 <br />616.89 <br />Register of Deeds <br />Hall POBOX 1692 � <br />Gr Island, NE�68802-1692 <br />�'otal <br />This notiee was prepared and signed at <br />the ' Oist day of D ecember <br />CHICAGO, 2L <br />2 011 <br />Signature <br />for PAMELA J ROGEBS <br />4CS W&I . . <br />(800) 829-765�0 <br />24915.51 i' <br />i� <br />;: <br />, �n this, •� _ <br />�', <br />`.: <br />� . . �. <br />i. <br />I. <br />i <br />E� <br />14-00-0000 ` <br />09/29/2020 <br />04/27/2021 <br />05/Q4/2021 <br />04/27/2021 <br />01/27/2021 <br />08/25/2020 <br />06/22/2021 <br />Use <br />:cording Office <br />� R 6ale - UCt FTL <br />Pes: 1 <br />1 10:58 RP9 <br />lQnp�id �alar�� <br />of Atisessment <br />(NOTE: Certlficate of offlcer authorized by law to take acknowledgm0nt is not essential to the•validity of-Notice oi Faderal Tax Don <br />Rev. Rul. 71 1971 �� 2 C .B. 4091 '' �� • ��� Porm 668(X)(c) IRev 2-2004) <br />• P�rt 1- Kept Bai R�etordi� A�ce ' C.�T. P10 60�2�X <br />