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(1 <br />02/04/2004 12:18 FAX 14024714429 NEBRASKA UCC <br />10 <br />Form 668 (Y) Department of the Treasury - Internal Revenue Service <br />(c) <br />(Rev. October 2000) Notice of Federal Tax Lien <br />Area: Serial Number For Optione <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (800) 829 -3903 153490004 <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. <br />Jame of Taxpayer SCOTT JANZEN <br />Use <br />U 003/004 <br />Office <br />Residence 621 BISCHELD ST <br />GRAND ISLAND, NE 68801 -7805 <br />200401068 <br />106 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />t� <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 />Kind of Tax <br />Tax Period <br />Ending <br />Date of <br />. Identifying Number Assessment <br />Last Day for <br />Refilling <br />Unpaid Balance <br />of Assessment <br />(a) <br />(b) <br />(c) (d) <br />(e) <br />(f) <br />1040 <br />12/31/2000 <br />506 -06 -9447 11/04/2002 <br />1.2/04 /2012 <br />5561.93 <br />1040 <br />12/31/2002 <br />506 -06 -9447 09/22/2003 <br />10/22/2013 <br />1892.62 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ 7454.75 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN <br />on this, <br />the 27th day of January 2004. <br />) :. <br />Signature ,r" Title <br />for S KILPATRICK;.,;" ACS 29 -00 -0008 <br />n <br />=` _ 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 CAT. NO 60025X <br />