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_- _____04/08/2004 16:52 FAX 14024714429 NEBRASKA UCC <br />1008 <br />9004/004 <br />Form 668 (Y)(c) <br />Department of the Treasury - Internal Revenue Service 200403500 <br />(Rev. February 20041 1 Notice of Federal <br />Tax Lien <br />Area: Serial Number For Optional Use by Recording Office <br />WAGE & INVESTMENT AREA #(5 <br />Lien. Unit Phone: (8o0) 829 -7650 165577904 Na go. .f state - ucc pry <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 9904327310 -6 Pa.: I <br />property belonging to this taxpayer for the amount of these taxes, and Filed! 04/0712004 ROBERT 04:19 PM <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer ROBERT E STUTZMAN <br />Residence PO BOX 92 <br />CAIRO, NE 68824 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed bjs�'Ihall, <br />unless notice of the lien is refiled by the date given in column (e), this notice on the day following such date, operate as a certificate of release as de <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 />Refiling <br />Unpaid Balance <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />M <br />1040 <br />12/31/1996 <br />507 -62 -0885 <br />10/27/2003 <br />11/26/2013 <br />2120.11 <br />1040 <br />12/31/1997 <br />507 -62 -0885 <br />10/13/2003 <br />11/12/2013 <br />2451.77 <br />1040 <br />12/31/1998 <br />507 -62 -0885 <br />10/13/2003 <br />11/12/2013 <br />2506.06 <br />1040 <br />12/31/1999 <br />507 -62 -0885 <br />10/13/2003 <br />11/12/2013 <br />2119.26 <br />1040 <br />12/31/2000 <br />507 -62 -0885 <br />10/20/2003 <br />11/19/2013 <br />2078.22 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ 11275.42 <br />Grand island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, M_-N <br />- on this, <br />the 31st day of March 2004 <br />Signature IL Title <br />a "s:fA�l6e ¢s ae ACS 15 -00 -0000 <br />for WANDA W. BROWN a- (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) <br />Part 1 -Kept By Recording Office Form 668(Y)(c) (Rev. 2 -2004) <br />r^T KOO Fnn)ru <br />