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11/29/2001 15:10 FAK_14024714429 NEBRASKA UCC <br />t <br />109 <br />Department of the Treasury - Internal Revenue <br />Form 668 (Y)(c) <br />(Rev. October 2000) Notice of Federal Tax Lien <br />Area: Serial Number For <br />WAGE`•& INVESTMENT AREA #5 <br />Lien Unit Phone: (800) 829 -7650 390151616 <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 penakies) <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, lntetlgst, and costs that may accrue. <br />Name of Taxpayer KEVIN K ROSE <br />Residence 7713 S ALDA RD <br />ALDA, NE 68810 -9633 <br />E T RELEASE INFORMATION: For each assessment listed below, <br />of the lien is refiled by the date given in column (e), this notice shall, <br />ollowing such date, operate as a certificate of release as defined <br />(a). <br />Q002/002 <br />12001 01:19 PM <br />200112211 <br />Place of Filing <br />Register of Deeds Total $ <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at MILWAUKEE, WI <br />the 26th day of November 2001 <br />43459.36 <br />, on this, <br />Signature r. Title <br />ACS 39 -01 -0000 <br />for J D EPPLER (800) 829 -7650 <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} (}1�[)(� <br />Part I - Kept B Recording Office Form 668( CAT {Rev. 1025X <br />Y CAT. NO 60025X } <br />9 <br />Tax Period <br />Date of <br />Last Dar�rr for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refiling <br />of Assessment <br />a <br />b <br />c <br />d <br />(e) <br />f <br />1040 <br />12/31/1990 <br />515 770 -6179 <br />03/22/1999 <br />04/21/2009 <br />9D96.47 <br />1040 <br />12/31/1991 <br />515 -70 -6179 <br />03/22/1999 <br />04/21/2009 <br />12085.82 <br />1040 <br />12/31/1992 <br />515 -70 -6179 <br />03/22/1999 <br />04/21/2009 <br />17838.98 <br />1040 <br />12/31/1993 <br />515 -70 -6179 <br />03/22/1999 <br />04/21/2009 <br />4438.09 <br />Place of Filing <br />Register of Deeds Total $ <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at MILWAUKEE, WI <br />the 26th day of November 2001 <br />43459.36 <br />, on this, <br />Signature r. Title <br />ACS 39 -01 -0000 <br />for J D EPPLER (800) 829 -7650 <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} (}1�[)(� <br />Part I - Kept B Recording Office Form 668( CAT {Rev. 1025X <br />Y CAT. NO 60025X } <br />9 <br />