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03/05/2004 09:36 FAX 14024714429 NEBRASKA UCC IA 004/004 Y, 5347 5347 Department of the Treasury - Internal Revenue Service form 666 (Y)(c) notice of Federal Tax Lien (Rev. February 2004) Area: Serial Number For Optional Use by Recording Office SMALL BUSINESS /SELF EMPLOYED AREA ##9 Lien Unit Phone: (651) 312 -8060 159713104 As provided by section 6321, 6322, and 6323 of the Internal Revenue Code, we are giving a notice that taxes (including interest and penalties) have been assessed against the following -named taxpayer. We have made a demand for payment of this liability, but it remains unpaid. Therefore, there is a lien in favor of the United States on all property and rights to property belonging to this taxpayer for the amount of these taxes, and additional penalties, interest, and costs that may accrue. Name of Taxpayer THOMAS A WAGONER so. of tier - ucc' Fri i 14321288 -1 Paz: 1 ONER THOMAS A ad; 03/03/2004 03723 PM Residence 2517 ARROWHEAD GRAND I S LAND , NE 68803 '200402079 IMPORTANT RELEASE INFORMATION: For each assessment listed below, unless notice of the lien is refiled by the date given in column (e), this notice shall, on the day following such date, operate as a certificate of release as defined in IRC 6325(a). Tax Period Date of Last Day for Unpaid Balance Kind of Tax Ending Identifying Number Assessment Refiling of Assessment (a) (b) c) (d) (e) (f) 1040 12/31/2002 506 -46 -0742 06/02/2003 07/02/2013 16602.04 Place of Filing Register of Deeds Hall POBOX 1692 Grand Island, NE 68802 -1692 This notice was prepared and signed at the 26th day of February 2004 Signature `��- xa=+ for KATHY MALLETT ST PAUL, MN Total 1$ 16602.04 ,on this, 61 Title REVENUE OFFICER. 29 -10 -1726 (402) 361 -0250 (NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien ; Acv Rid 71 -466. 1971 - 2 C.B. 4091 - Form 668(Y)(c) (Rev. 2 -2004) ,r-