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02/10/2004 11:35 FAX 14024714429 NEBRASKA UCC <br />:r <br />IM 003/003 <br />This notice was prepared and signed at ST PAUL, MN <br />the 04th day of February 2004 <br />Signature w , Title <br />' R}N30F8 <br />6667for KAY PON�" 30884 <br />on this, <br />r , <br />29 -10 -2339 <br />(NOTE: Certificate of officer authorized by law to Iake acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />RP.\!. Rid. 71 -466. 1971 - 2 C.B. 4091 <br />1008 <br />Department of the Treasury - Internal Revenue Service <br />Form 668 (Y)(c) <br />Notice of Federal Tax Lien <br />(Rev. October 2000) <br />Area: Serial Number For Optional Use by Recordina Of' <br />i1L <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (651) 312 -8080 155822204 <br />at s�, . ucc <br />�c <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 A31738g' GpRPORgS 49 <br />g9® ' <br />property belonging to this taxpayer, for the amount of these taxes, and j20mA <br />F a 021 <br />ad: <br />additional penalties, interest, and costs that may accrue. F1' <br />Name of Taxpayer A & N INC , .a Corporation <br />Residence 228 CHEROKEE AVE <br />GRAND ISLAND, NE 68803 -3803 <br />RTANT RELEASE INFORMATION: For each assessment listed below, <br />otice of the lien is refiled by the date given in column le), this notice shall, <br />E <br />day following such date, operate as a certificate of release as defined <br />6325(a). <br />Tax Period Date of Last Day for Unpaid Balance <br />Kind of Tax Ending identifying Number Assessment Refiling of Assessment <br />(a) (b) (c) (d) (e) (f) <br />940 <br />12/31/2002 <br />47- 0791041 <br />10/13/2003 <br />11/12/2013 <br />73.37 <br />941 <br />06/30/2002 <br />47- 0791041 <br />10/06/2003 <br />11/05/2013 <br />912.95 <br />941 <br />09/30/2002 <br />47- 0791041 <br />10/06/2003 <br />11/05/2013 <br />5667.66 <br />941 <br />12/31/2002 <br />47- 0791041 <br />10/20/2003 <br />11/19/2013 <br />4794.55 <br />941 <br />03/31/2003 <br />47- 0791041 <br />11/10/2003 <br />12/10/2013 <br />2822 -96 <br />941 <br />06/30/2003 <br />47- 0791041 <br />10/20/2003 <br />11/19/2013 <br />1751.26 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692. Total <br />$ 16022.75 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN <br />the 04th day of February 2004 <br />Signature w , Title <br />' R}N30F8 <br />6667for KAY PON�" 30884 <br />on this, <br />r , <br />29 -10 -2339 <br />(NOTE: Certificate of officer authorized by law to Iake acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />RP.\!. Rid. 71 -466. 1971 - 2 C.B. 4091 <br />