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07/07/2004 16:08 FAX 14024714429 NEBRASKA UCC Ij003 /004 200405732 1008 Department of the Treasury - Internal Revenue Service Form 668 (Y)(c) (Rev. February 2004) Notice of Federal Tax Lien Area: Serial Number For Optional Use by Recording Office SMALL BUSINESS /SELF EMPLOYED AREA #9 Lien Unit Phone: (800) 829 -3903 179138204 WE sae of slate - ucc FTL 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 99!4341304 -1 pas: 1 property belonging to this taxpayer for the amount of these taxes, and Field: 07 /07 /2e04 11:69 AM additional penalties, interest, and costs that may accrue. Name of Taxpayer PHILLIP J TUREK Residence 362 S 130TH RD WOOD RIVER, NE 68883 -9773 RTANT RELEASE INFORMATION: For each assessment listed below, notice of the lien is refiled by the date given in column (e), this notice shall, E day following such date, operate as a certificate of release as defined 632b(a). Tax Period Date of Last Day for Unpaid Balance Kind of Tax Ending Identifying Number Assessment Refiting of Assessment (a) (b) (c) (d) (e) (f 1040 12/31/2002 505 -92 -3980 05/26/2003 06/25/2013 9826.54 Place of Filing Register of Deeds Hall POBOX 1692 Total $ 9826-S4 Grand Island, NE 68802 -1692 This notice was prepared and signed at the 25th day of June I►1I, ST PAUL, MN on this, 1, f � G% Signature Title ACS 29 -00 -0008 for S KILPATRICK (800 ) 829 -3903 (NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien Rev. Rul. 71 -466, 1971 - 2 C.B. 409) _ ., — — ..« Form 668(Y)(c) (Rev. 2 -2004) s