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01/14/2004 17:29 FAX 14024714429 NEBRASKA UCC f 003 <br />r)" 5169 <br />Department of the Treasury - internal Revenue Service <br />Form 66B (Y)(c) <br />(Rev. October 2000) Notice of Federal Tax Lien <br />Area: Serial Number For Optional Use by Recordina Offi- <br />SMALL BUSINESS /SELF EMPLOYED AREA ##9 7 <br />Lien Unit Phone: (651) 312 -6080 150788904 ME New 9t S"" - a« cry <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, Pa„ 1 <br />there is a lien in favor of the United States on all property and rights to 9904 ;32438 -7 <br />FRIESEN TODD W I <br />property belonging to this taxpayer for the amount of these taxes, and Filed: 01113/2004 04.16 PM <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer TODD W FRIESEN <br />Residence 4134 W FAIDLEY <br />GRAND ISLAND, NE 68803 -3327 <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 following such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />T <br />Kind of Tax <br />ax Period <br />Ending <br />Identifying Number <br />Date of <br />Assessment <br />Last Dayy for <br />Refiling <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />1040 <br />12/31/1997 <br />506 -92 -6717 <br />09/21/1998 <br />10/21/2008 <br />1040 <br />12/31/2000 <br />506 -92 -6717 <br />05/28/2001 <br />06/27/2011 <br />Place of Filing <br />00040053'7 <br />Register of Deeds <br />Hall POBOX 1692 Total $ <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 07th day of January <br />2004 <br />ST AAITT, _ MTT <br />Unpaid Balance <br />of Assessment <br />1936.32 <br />6427 -98 <br />8364.30 <br />, on this, <br />C) <br />Signature�„ Title <br />5 ct69':' - ACS 29 -00 -0008 <br />for S KILPATRICK (800) 829 -3903 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 10 -00) <br />Part 1 -Kept By Recording Office Form <br />NO 60025X <br />