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ADAMS COUNTY, N~
FILED
INST. NO ~~ ~ ~
/Date .~2:r1$ Time ~' ~ Y~.,2'~
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Vf REGISTER OF DEEDS
RESERVED FOR REGISTER OF DEEDS RECORDING SPACE
ADAMS COUNTY NE
PAGE 1 OF PAGES
03/27/600$ TIIU ! ~: 39 F'AS. 4r)~ 4'11 4429 UCC SECRETA~?Y OP STA'_T.;' -~-~-~ Adams [~003Jn,~4
2~( 08129.E
.~L~,~ 3 f~ 8 2 ""."_..,.~ _..__.
Department of the Treasury -internal Revenue Service
Form b68 (Y)(c) Notlc¢ 9f Federal Tax LierY
(Rev. Fabruarf 2Cr?4)
Area: ~ Serial Number For o bona! UsP by Recordin Office
SMALL 13USINES3%Sr^,LF Eh1PL()'YEU AI2EP, ##4
Lien Unit Phone: (eoD) 913-6050 436709108 „€ see os sre}e Ir. hn A Geie - OCC FTL
As provided by section 4321., s33'~2, and 6323 of the Internal Revenue ~ I ~ f~f
Code, we are giving a notice thaw taxes (Including Interest and penaides) ~ ~ ~ I
have been assessed against the following-Warned taxpa~rer. We have made I f ~~
a demand for payment of this liability, but it remains unpaid. Therefore,
there is a lien ire favor of the United Scares on all property and rights tD gg®8ss3ssl-1 ~~: +
raper belonging tD this to a er far the arnOUnt of these taxes, dnd KOHL ROpM D III
p ~/ Xp y F i lad: 0312,'1 20~i8 03:28 P~ ~
additional penalties, interest, and casts that may accrue.
Name of Taxpayer ADAM U KOHL IZI
t3esidence '1426 W 2ND ST
I-%fiSTITiGS, NE 6890].-4961
IMPORTANT RELEASE INfFORMATIONc For each assessment Gstad below,
unless notioe of the lien is refiled by the date given in column {e), thin notice shalt,
vn the day follovving such date, operate as a certificate of release as defined
in IRC 8325(ai.
Tax Period f7ate of Last Dayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) _ (C) (d) (~) (f)
941 [ib/30 j X00'7 47-0$43648 411'07/2005 02/+:70/2018 3513.50
941 09f30/Z4U7 47-0803648 01%07/2008 02/06/2013 ~ 3471.41
Fiar:e of Filing
Register of Deeds
Adams Caurty
±-i4tyt:ings, NF 6$°Oi
This notice was prepared and signed at
CHTCAGQ, IL
Total I
6584.91
on this,
the 18th day of ~Pdarcn_ 2448
Signature 1~- ~~~ ~~ ~ Title
1 REVENUE OF~'ICEtt 24-10-2339
far KAY' PONTE ~ (308) 3$4.-4x50_
(NOTE: Certificate of officer authorized by !aw to ta~.e acknewledgrner.t is not essential m tr•~e vailtl;ty at rvcuce or reuerat + ax aen
Rev. Rul. 71-466, 9971 - 2 (;.E. 409) Fcrrn 668(`t7(ca (Flee. 2-2.004;~~~~
Part 1 -Kept By Retarding Office ;CAT. NO 60U25X ~ ~,~(
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