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ADAMS COUNTY NE
FILED
.INST. N0.~2,~.$: j~ 2 5 2
Date ~2 8 Time;
~~~'
REGISTER OF DEEDS
RESERVED FOR REGISTER OF DEEDS RECORDING SPACE
ADAMS COUNTY NE
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01122{2~pC~ '!'1JE ii:~(, .A:. "_i)c 4'7] •2d;i9 'v'C'', Sli':~~P"P~-? ~ ~,_
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Pur[n 66fi (Y)(cj Gepartmen~ °# the Ire«s;;ry -Interns! Ravenue Service
(Rev. February 2004) Nfotice o~ ~edera[ Tax LCf~n
Area: ~~~ Sena! 'umber Far Ors?rora~ Use ;•
SMALL BlTS1J.VE;SS/uEL^ EM%LCYti,);~ r'1p~,I1 ~~ by F9COrctn~ rJffice ~-
Lien Unit Phane: !Et~O; 9X~ •-5ci5t1 i-_
_ _ 4144.51F308 ne suc ~r stelo aa,.. a e„a - uec an.
As prcrvidr~d bar section £3.21, h322, and b323 a€ the Inte;~t~ai itevenue i ail ~ '' ~ '~I +
Cade, we are giving' a notice f:lsat xaxes ,(including i~yterest and penalties) I
have been assessed againsF the following-Warned ta7tysayes. We Rave trade ~~ 1
a demand for payment s~f this liabliity, but it remaltl5 Unpaid. 7herefare, ~ I!~ i ~I
there is a Tien in favor of the I1S1iteCl States on all propert~p and rlghrs to
,property belonging to this taxpayer for the amount of tia+ESe taxes, and 980554415x•-3 Pg:: t
~~2gHAM 3E5SE
additional penalties, interest, aricl costs Shat ana3r accrue, Ftiaa: eirz2~zr,~s sm o~ i~M
Name of Taxpayer JESSE GRAI~M --_
IiesidPnce !'O BOA :321. _ ."_°....._.__.....~._,__-- --
z-iAS'1.'LNCS, P7'F, 6~~a02-0321
iM1'attTANT R.i:l.i;ASI: II+i~8i1tMATIONa For each assessrnent listed befoNr,
unless notice of tits Hen Is refilEd by the date g;var+ in column {6L this notiro shall,
nn the day follo:nring. such date, cpsrats as a certificate o1 release as definwd
in lRG 6325{a},
T'aac Penod Bate of Last Day for ~inpaid Balance
Kind a+l" Tax , Ilrndin,g l+~e~tf~riryg irtumber l~sessment Rei3ling• +af Assessment
t~3 i ray ,_. ...
~a~
/- /J~.
94Q 12 31 f 20Ur' '7'_~-^983=~39 12 lU %,,07 07. j 09/z 0:i~s 133 . Q9,
y4~- 03/3iJ200£ 7~i-<i585~#39 10 /O 1/2U07 16/37 /2G17 22.22.50
941 06/30/20rJE 75-2963439 1Q/U1/2007 10/:31%~G17 ]OgS,~r
941• U9/30/2006 75•-2y85439 10/O1/20C7 li/31/2U1'7 i03~,4~
p
Place of Filing
~eaisLeY c; f' ~.aeea.s
~admc~ Cc,~t.~t;y -total $ 44:37.74
Has~.iny.s, Ni$ b89U1
This notice was prepares! and signed at __ ~`~' ,P~iTJG, P?-1+1 ;
-- --- , an lots,
the ~ ~ lt:h day of -_-`Tar~uary 2008
Signsture ~ '7 ~ _~ _-
i
RE~>~RTfJE OFFICER 24_1C-2339
for KAX ~ONTE 1308) 3634-4850
(NO3'E: Certificate of offir,~er authorized by law to ?akr; arkno'~uiedgment is rat essen*ial to the validity o; i`otice of Federal lax lien
Rev. Rul, 71.466. 1971 - 2 C.B. 409)
Fart f -Kept !#y Itecordiag Office rorm bbfJ('j(cj ;Rev. 7_-20041
KCAL NO 50026X 1r
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