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03/05/2004 09:35 FAX 14024714429 NEBRASKA UCC <br />Y <br />(; 1008 <br />Department of the Treasury - Internal Revenue Service <br />Form 668 (Y)(c) <br />,Rev_ February 20041 Notice of Federal Tax Lien <br />IA 002/004 <br />Area: <br />Serial Number <br />For Optional Use by Recording Office <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (651) 312 -8080 <br />159552204 <br />s.e .� s�.�.:- ua srL <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 followin"amed 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 />WR 284- a po ■; f <br />MRS <br />property belonging to this taxpayer for the amount of these taxes, and <br />F11W: 03/03/2004 03:23 pM <br />additional penalties, Interest, and costs that may accrue. <br />200402078 <br />Name of Taxpayer THOMAS 'A WAGONER <br />Residence 1819 W NORTH FRONT ST <br />GRAND ISLAND, NE 68803-4706 <br />ORTANT RELEASE INFORMATION: For each assessment listed below, <br />s notice of the lien is refiled by the date given in column (e), this notice shall, <br />E <br />e day following such date, operate as a certificate of release as defined <br />C 6325(a). <br />Tax Period <br />Date of <br />Last Day 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 />941 <br />12/31/2001 <br />47- 0550792 <br />11/18/2002 <br />12/18/2012 <br />941 <br />12/31/2001 <br />47- 0550792 <br />01/27/2003 <br />02/26/2013 <br />902.46 <br />941 <br />03/31/2002 <br />47- 0550792 <br />10/28/2002 <br />11/27/2012 <br />941 <br />03/31/2002 <br />47- 0550792 <br />01/27/2003 <br />02/26/2013 <br />705.43 <br />941 <br />03/31/2003 <br />47- 0550792 <br />02/09/2004 <br />03/11/2014 <br />18'/6.62 <br />941 <br />06/30/2003 <br />47- 0550792 <br />02/02/2004 <br />03/04/2014 <br />1831.30 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 5315.81 <br />Grand Island, NE 68802 -1692. <br />This notice was prepared and signed at ST PAUL, MN <br />the .26th day of February 2004 <br />on this, <br />N Y... <br />Signature Title <br />A s'i.�p` REVENUE OFFICER 29 -10 -1726 <br />RE <br />iq <br />for KATHY MALLETT -` "'y `�' (402) 361 -0250 <br />(NOTE: Certificate of officer authorized bylaw to take acknowledgment is not essential to the validity of.Notice' of Federal T.ax lien <br />Rev. Rut. 71-466,1971 - 2 C.B. 409) Form •668(Y)(t) (Rev_ 2 -2004) <br />