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01/22/2004 10:03 FAX 14024714429 NEBRASKA UCC Iii Form 668 (Y)(ci (Rev. October 200 0) QMAI T._$zT$IDT.E- Sq /SF:TF T?.MPLQYE- -_ Lien Unit Phone: (800) 629 -3903 152011404 As provided by section 6321, 6322, and 6323 of the Internal Revenue Code, we are giving a notice that taxes .(Including Interest and penalties) have been assessed against the following -named taxpayer. We have made a demand for payment of this liability, but it remains unpaid. Therefore, there is a lien in favor of the United States on all property and rights to property belonging to this taxpayer for the amount of these taxes, and additional penalties, interest, and costs that may accrue. Name of Taxpayer DENNIS D NELSON pepartment of the Treasury_ - Internal Revenue Service_ Notice of Federal Tax Lien Residence 3579 N HIWAY 281 GRAND ISLAND, NE 68801 T RELEASE INFORMATION: For each assessment listed below, of the lien is refiled by the date given in column o (e), this notice shall, ollowing such date, operate as a certificate of release as defined a). Tax Period Date of Last Day for I (ind of Tax Ending Identifying Number Assessment Refilmg (a) (b) (c) (d) (e) 1040 12/31/1998 505 -70 -9068 11/04/2002 12/04/2012 1040 12/31/1999 505 -70 -9068 10/21/2002 11/20/2012 1040 12/31/2000 505 -70 -9068 12/16/2002 01/15/2013 1040 12/31/2001 505 -70 -9068 12/23/2002 01/22/2013 Place of Filing Register of Deeds Hall POBOX 1692 Grand Island, NE 68802 -1692 This notice was prepared and signed at the 16th day of January 2004 ST PAUL, MN 1� 002/002 12004 12A0 PM 200400645 Unpaid Balance of Assessment 5214.15 5559.01 16894.44 8762.26 Total 1$ 36429.86 , on this, Signature ACS 29-00-0008 -Fn-r- �q VTT.Pj To •1 '°'*' (80C) 829 -3903 (NOTE: certificate of officer authorized by iaw to take acknowledgment is not essential to the validity of Nottce of r-eoerai i ax uen - . _. 1 1 0 nnai Form 668(Y)(c) (Rev, 10 -00)