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07/21/2004 16:39 FAX 14024714429 NEBRASKA UCC <br />0 <br />Form 668 (Y)(c) <br />(Rev. February 20041 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />0003/006 <br />Area: <br />Serial Number <br />For Optional Use by Recording Office <br />s�o ni ucc <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (651) 312 -8080 <br />181385004 <br />Fri <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 />9994343258 -4 <br />there is a lien in favor of the United States on all property and rights to <br />MITCHELL CHRIS <br />property belonging to this taxpayer for the amount of these taxes, and <br />Filed; 07/21/2004 03:32 PM <br />additional penalties, interest, and costs that may accrue. <br />200407199 <br />Name of Taxpayer CHRIS MITCHELL <br />Residence 13550 W PLATTE RIVER DR <br />WOOD RIVER, NE 68883 -9526 <br />TANT RELEASE INFORMATION: For each assessment listed below, <br />tice of the lien is refiled by the date given in column lei, this notice shall, <br />E <br />ay following such date, operate as a certificate of release as defined <br />325fa1. <br />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refilling <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />941 <br />09/30/1998 <br />42- 1470818 <br />03/22/1999 <br />04/21/2009 <br />257.27 <br />941 <br />12/31/1998 <br />42- 1470818 <br />03/15/1999 <br />04/14/2009 <br />320.14 <br />941 <br />03/31/1999 <br />42- 1470818 <br />10/04/1999 <br />11/03/2009 <br />1131.4 <br />941 <br />06/30/1999 <br />42- 1470818 <br />10/11/1999 <br />11/10/2009 <br />941 <br />06/30/1999 <br />42- 1470818 <br />03/25/2002 <br />04/24/2012 <br />6070.88 <br />Place of Filing <br />Register of Deeds <br />Hall PODOX 1692 Total <br />$ 7779.70 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 12th day of July <br />2004 <br />ST PAUL, MN <br />on this, <br />J <br />Signature F W Title <br />/ REVENUE OFFICER 29 -10 -2341 <br />for PAT KELLOGG -14A' (3 08) 384 -6662 <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 />AT Form 668( (Rev. 2 -20 <br />Part 1 - Kept By Recording Office CAT. NO 60025X X <br />