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03/09/2001 18:09 FAX 14024714429 NEBRASKA UCC la 002/002 <br />-n� �� or Sibiu - lllltl VrL <br />16047 r - Internal Revers 990i%2303!; �l111�1f��4�1�����ll�l���i <br />Department of the Treasury TRI STATE FLOORING INC A CORPO <br />Form 668 (Y)(c) Notice of Federal Tax Lien F�1 °d` 03/0912001 02 BG PM <br />(Ray. October 200Di <br />Area, Serial Number 1 For Optloral Use by Recording Office <br />SNI;aLL BUSINESS /SELF EMPLOYED AREA #9 390142920 <br />Lien Unit Phone: (414) 297 -3211 <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that taxes (including interest and penalties) <br />have been assessed 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 united States on all property and rights to ((�� <br />property belonging to this taxpayer for the amount of these taxes, and 200101913 <br />additional penalties, Interest, and costs that may accrue. <br />flame of Taxpayer TRI -STATE FLOORING INC , a Corporation <br />Residence 2626 OLD FAIR RD <br />GRAND ISLAND, NE 68803 -5219 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />L17 ss notice of the lien is refiled by the date given in column (e), this notice shall; <br />he day following such date, operate as a certificate of release as defined <br />RC 0325(x). <br />Tax Period Date of Last Day for Unpaid Balance <br />Kind Ending Identlfyiag Number Assessment Refiling of Assessment <br />941 <br />12/31/1998 <br />91- 1862198 <br />03/15/1999 <br />04/14/2009 <br />433.72 <br />941 <br />03/31/1999 <br />91- 1862198 <br />11/01/1999 <br />12/01/2009 <br />4839.73 <br />941 <br />06/30/1999 <br />91- 1862198 <br />05/01/2000 <br />05/31/2010 <br />4627.68 <br />941 <br />09/30/1999 <br />91- 1862198 <br />11/22/1999 <br />12/22/2009 <br />6182.87 <br />941 <br />12/31/1999 <br />91- 1862198 <br />04/10/2000 <br />05/10/2010 <br />2953.13 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE <br />This notice was prepared and signed at <br />the 02nd day of March <br />68802 -1692 <br />2001 <br />MILWAUKEE, WI <br />Total 1$ <br />19037.12 <br />, on this, <br />Signature Title <br />Revenue Cff�cer 39 -01 -2341 <br />for PATRICK KELLOGG 1 (303) 385 -6548 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien I <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 409! Form 668(Y)(c) [Rev. 10 -00)) <br />Part 1 - Kept by Retarding Office reT nin Fnnoax <br />