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07/23/2004 16:47 FAX 14024714429 NEBRASKA UCC Q 004 <br />N S4.4. - NCC FTl <br />98i4343SW7 Pe.: 2 <br />ESTATE OF JOIN C. DAVIS <br />Filed. 0712312004 63:63 PM <br />200407338 <br />Form 668 -H <br />Department of the Treasury — Internal Revenue Service <br />(Rev. Nov. 1999) <br />Notice of Federal Estate Te= Lien Under the Internal Revenue Laws <br />District: Small Business /Self <br />Serial Number: <br />For Optional Use by Recording <br />Employed #9 <br />Office <br />Notice is given under the provisions of section 6324B of thbinternal <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 />Date of Death: <br />Decedent's Social Security Number: <br />Amount of Additional Tax: <br />04 -01 -2002 <br />508 -18 -9449 <br />S 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 />SEE ATTACHED LEGAL DESCRIPTION <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, 190' day of July 2004. <br />Signatur : <br />Title: Technical Services Group Manager <br />TO BE KEPT BY THE RECORDING OFFICE <br />Form 668 -H (Rev 11 -99) <br />