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04/08/2004 16:51 FAX 14024714429 NEBRASKA UCC <br />1008 <br />Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service <br />IRev, February 2004) Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA ##9 <br />Serial Number For Optionaf Use by Recording Office <br />Lien Unit Phone: (80o) 829 -3903 165853304 s�.�. uCc FTL <br />wr s.s es - <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 9904327308 -1 <br />property belonging to this taxpayer for the amount of these taxes, and EVWS Ross L <br />additional , Filed: 04/07!2004 04:13 PM <br />penalties interest and costs that may accrue. <br />Vame of Taxpayer ROSS L EVANS Cr 7- /r16 L /-/ <br />Residence PO BOX 2412 <br />GRAND ISLAND, NE 68802 -2412 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column le), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />Kind of Tax <br />Tax Period <br />Ending <br />Identifying Number <br />Date of <br />Assessment <br />Last Day for <br />Refilling <br />Unpaid Balance <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />if <br />1040 <br />12/31/1999 <br />508 -98 -7032 <br />07/15/2002 <br />08/14/2012 <br />2637.30 <br />1040 <br />12/31/2000 <br />508 -98 -7032 <br />03/10/2003 <br />04/09/2013 <br />4869.65 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ 7506.95 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN <br />on this, <br />01st April 2004 -� - =-� <br />the - -- day of P <br />Signature Title ' <br />ACS <br />for S KILP 7 "- <br />(800) 829 -3903 29 -00 -0008 <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) <br />- - -- - -- .__._ .,ec Form 668(Y)(c) (Rev. 2 -2004) <br />f <br />