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11/15/2001 16:59 FAX 14024714429 NEBRASKA UCC <br />109 <br />Department of the Treasury - Internal Revenue <br />Form 668 (Y)(c) <br />(Rev. October 20001 Notice of Federal Tax Lien <br />Area; Serial Number Fo' <br />SMAL:k BUSINESS /SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (414) 297 -3211 390151431 <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 Habi>ity, but it remains unpaid. Therefore, <br />there is a lien In favor of the United States on aff 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. <br />Name of Taxpayer JERRY J & LINDA J HANSEN <br />Residence 414 W 9TH ST <br />WOOD RIVER, NE 68883 -9105 <br />Q004 /004 <br />FTL <br />200111783 <br />Unpaid Balance <br />of Assessment <br />Place of Filing <br />Register of Deeds Total $ <br />Hall POBOX 1692 1797.98 <br />Grand Island, NE 68602 -1692 <br />This notice was prepared and signed at MILWAUKEE, WI <br />the 0 9 th day of November 2001. <br />, on this, <br />Signature Title <br />Revenue Cfficer 39 -01 -2337 <br />for MICHAEL PONTE (308) 384 -6668 <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 -488, 1971 - 2 C.B. 409) Form 668(Y)(0 (Rev. 10 -00) <br />Part 1 • Kept By Recording Office CAT. NC 60025X <br />