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{{�� 06/22/2001 15:14 FAX 14024714429 NEBRASKA UCC <br />b% <br />[a 005 /005 <br />111111! <br />IlIII IIlII II III IIIII Illil III! III <br />109 <br />Department of the Treasury - Internal Revenue 9901151243 <br />JEWELL. <br />Pas t <br />JERRY W SR <br />Form 669 (Y)(c) e Fl Lad: 06122/2001 02.35 PM <br />Notice of Federal Tax Uen - - - - -- — - -- -- <br />(Rev. October 20001 <br />Area: <br />Serial Number <br />For Optional Use by Recording Office <br />SMALL BUSINESS /SELF EMPLOYED AREA 49 <br />Lien Unit Phone: (414) 297 -3211 <br />390147891 <br />As provided by section 6321, 631:2, 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 as property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, Interest, and icasts that may accrue. <br />Name of Taxpayer JERRY W JEWELL JR <br />200106171 <br />Residence 2323 BELLWOCD APT 52 <br />GRAND ISLAM, NE 68801 -6204 <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 fcUowing such date, operate as a certificate of release as defined <br />in IRC 63261a). <br />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refilling <br />of Assessment <br />a <br />b <br />c <br />d <br />e <br />f) <br />1040 <br />12/31/1994 <br />351 -62 -9022 <br />12/01/1997 <br />12/31/2007 <br />7369.93 <br />f� <br />Place of Filing <br />Register of Deeds Total <br />$ <br />Hall POBOX 1692 <br />7369.93 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />MILWAUKEE, WI <br />the 18th day of June 2001. <br />Signature <br />Revenue Officer 39 -01 -2341 <br />for PATRICK KELLCGCI7Zt (308) 385 -6548 _ <br />(MOTT: Certificate of officer authorized by law to take ackrowledgment is not essential to the validity of Notice of rederal Tex lien <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 409) <br />Part 1 - Kept By Reeordins Office Form 666( CAT {Rev. 10 5X <br />CAT. NO 60025X <br />Title <br />, on this, <br />