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03/16/2004 16:51 FAX 14024714429 NEBRASKA UCC <br />r <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />5347 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />rhea: I Serial Number <br />SMALL BUSINESS /SELF EMPLOYED AREA ##9 <br />Lien Unit Phone: (651) 312 -8080 162235704 <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 />Vane of Taxpayer GARY M BURRIS <br />IMPERIAL CLEANERS AND LAUNDRY <br />Residence 1927 N BROADWELL <br />GRAND ISLAND, NE 68803 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <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 />10004/008 <br />For Optional Use by Recording Office <br />Kind of Tax <br />(a) <br />Tax Period <br />Ending <br />(b) <br />Identifying Number <br />(c) <br />Date of <br />Assessment <br />(d) <br />Last Day for <br />Refilling <br />(e) <br />940 <br />12/31/1988 <br />47- 0707214 <br />10/18/1999 <br />11/17/2 "009 <br />941 <br />12/31/1995 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />03/31/1996 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />06/30/1996 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />09/30/1996 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />12/31/1996 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />03/31/1997 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />06/30/1997 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />09/30/1997 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />12/31/1997 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />03/31/1998 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />06/30/1998 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />09/30/1998 <br />47- 0707214 <br />05/10/1999 <br />06/09/2009 <br />941 <br />03/31/1999 <br />.47- 0707214 <br />08/18/2003 <br />09/17/2013 <br />941 <br />03/31/2000 <br />47- 0707214 <br />06/05/2000 <br />07/05/2010 <br />Place of Filing <br />200402568 <br />Unpaid Balance <br />of Assessment <br />277.48 <br />2606.40 <br />2225.70 <br />2721.81 <br />2632.76 <br />2453.84 <br />2462.76 <br />2662.95 <br />1807.86 <br />1194.26 <br />1165.66 <br />1289.54 <br />1719.82 <br />2208.92 <br />25.13 <br />Register of Deeds <br />Hall POBOX 1692 Total $ 27454.89 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN , on this, <br />the 11th day of March 2004 <br />Signature <br />€,tw r ro Title <br />REVENUE OFFICER 29 -05 -1217 <br />for MARY MORGAN (712) 274- 1735 <br />(NOTE: Certificate of officer authoeized 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) _ <br />