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06/29/2004 15:45 FAX 14024714429 NEBRASKA UCC <br />lzl� <br />200406'742 <br />0002 /003 <br />NY s.. K S40" _ ucc <br />FTL <br />8904340307 -2 pat: t <br />Filod: 08/29,2804 DAV68 AM <br />Form 668 -H <br />Department of the Treasury — Internal Revenue Service <br />(Rev. Nov. 1999) <br />Notice of Federal Estate Tax Lien Under the Internal Revenue Laws <br />District: Small Business /Self [Serial Number: <br />For optional Use by Recording <br />Employed #9 <br />office <br />Notice is given under the provisions of section 6324B of the Internal <br />Revenue Code that a lien exists in favor of the United ,States against the <br />specific property described below for additional Federal estate tax <br />imposed by section 2032A (c) due to the special valuation elected under <br />section 2032A, and / or section 2057 (f). <br />X Section 2032A (c) <br />Section 2057 (f) <br />Name of Estate: Estate of John C. Davis <br />Name and Address of agent designated by the qualified heirs for dealing with the <br />IRS. <br />Daniel P. Davis <br />14960 W. Cedarview Road <br />Wood River, NE 68883 <br />------------ <br />Date of Death: <br />04 -01 -2002 <br />Decedent's Social Security Number: <br />Amount of Additional Tax: <br />508 -18 -9449 <br />$ 295,063.00 <br />Description of Property to Which Lien Attaches: Qualified Heirs: Frances T. Davis, John T. <br />Davis, James D. Davis, Daniel P. Davis, Michael J. Davis, Kevin A. Davis and Karen A. Rieke <br />The East Half of the Southeast Quarter (E1 12 SE1 /4) of Section Fourteen (14), <br />Township Ten (10) North, Range Twelve (12) West of the 6th P.M., Hall <br />County, Nebraska <br />Part of the Northeast Quarter (NE1 1 4) and part of the East Half of the <br />Northwest Quarter (E1 12 NW1 /4) of Section Twenty -nine Township <br />(29), Ten <br />(10) North, Range Twelve (12) West of the 6th P.M., Hall County, Nebraska <br />Place of Filing: County Recorder <br />Hall County <br />Grand Island, NE 68801 <br />This notice was prepared and signed at Saint Paul, Minnesota, on this, 23rd day of June , 2004. <br />Signature: <br />Title: Technical Services Group Manager <br />TO BE KEPT BY THE RECORDING OFFICE <br />Form 668 -H (Rev 11 -99) <br />