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v <br />04/23/2004 16:17 FAX 14024714429 NEBRASKA UCC IM004/004 <br />100 <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />2004040!( <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Number <br />SMALL BUSINESS /SELF EM2LCYUD AREA 49 <br />Lien Unit Phone: (80o) 829 -3903 168629104 <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 />Name of Taxpayer DENNIS H COLVIN <br />Residence 412 1/2 WEST DIVISION <br />GRAND ISLAND, NE 68801 -6512 <br />For Option_ al Use by Recording Office <br />WE S.e of 14.1. - UCC FTL - <br />i <br />9904330308 -6 Pas; 1 <br />COLVIN DENNIS H <br />Filed: 04/23/2004 ®2:47 PM <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in colurnn (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 />Tax Period Date of Last Dayy for <br />Kind of Tax Ending Identifying Number Assessment Refiiiing <br />(a) (b) I (c) (d) (e) <br />1040 112/31/19981 518 -68 -0295 09/08/2003 10/08/2013 <br />1040 12/31/1999 518 -68 -0295 09/08/2003 10/08/2013 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN <br />the 20th day of April 2004 <br />Unpaid Balance <br />of Assessment <br />1673.92 <br />6804.90 <br />Total 0 8478.82 <br />on this, <br />"V <br />Signature Title <br />y ## - ACS 29 -00 -0008 <br />for S KILPATRICK (800) 829 -3903 <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 -46B, 1971 - 2 C.B. 409) ( �( <br />Form 666 i c ) (Rev. 2 -2004) <br />Part i - Keot By Recording Office — <br />