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06/12 /2001 10:07 FAX 14024714429 NEBRASKA UCC Z002/002 <br />i I <br />WE 5— Ia+ Siaiv" - UICC FTL <br />Department of the Treasury - Internal Revenue Sery <br />)Form 668 M(c) 9901148452 P93 1 <br />e00M RICHaRD D <br />Notice of Federal Tax Lien <br />IRev. October 2000) F1 ied e6r 11 / 2001 04:22 PM <br />Area: Serial Number For Oprtional Use by Recording Office <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (414) 297 -3211 390147238 <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 <br />additional penalties, interest, and costs that may accrue. 200105634 <br />Name of Taxpayer RICHARD D & REBECCA R BUSBOOM <br />Residence 1234 2,TD AVE <br />DANNEBROG, NE 68831 -3528 <br />L MPORTANT RELEASE INFORMATION: For each assessment listed below, <br />nless notice of the lien is refiled by the date given in column (e), this notice shall, <br />n the day following such date, operate as a certificate of release as defined <br />1RC 8325(al. <br />Tax Period Date of Last Day for Unpaid Balance <br />Kind of Tax Ending identifying Number Assessment Refilling of Assessment <br />1040 <br />12/31/1995 <br />505 -56 -5750 <br />03/16/1998 <br />04/15/2008 <br />1007.96 <br />1040 <br />12/31/1996 <br />505 -56 -5750 <br />02/09/1998 <br />03/10/2008 <br />716.32 <br />1040 <br />12/31/1997 <br />505 -56 -5750 <br />11/27/2000 <br />12/27/2010 <br />9120.09 <br />Place of Filing <br />Register of Deeds Total <br />$ <br />Hall POBOX 1692 <br />10844.37 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at MILWAUKEE, WI , on this, <br />the 04th day of June 2001 <br />Signature T le <br />evenue Officer 39 -01 -2341 <br />for PATRICK KE OGG (308) 385 -6548 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice or Federal Tax lien <br />Rev. Rul. 71-466,1971 - 2 C.B. 409) Form 668(Y)(c) IRev. 10.00) <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />