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07/27/2004 15:33 FAX 14024714429 NEBRASKA UCC 4` IA 002/002 1008 Department of the Treasury- Internal Revenue Service Form 668 M(c) Notice of federal Tax Lien (Rev. February 2004) Serial Number For Optional Use by Recording Office Area: W saa of stare - Me rrL SMALL BUSINESS /SELF EMPLOYED AR #9 182233304 Lien Unit Phone: (800) 829 -3903 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 (!ability, but it remains unpaid. Therefore, 9904343919 -5 Pus: 1 there is a lien in favor of the United States on all property and rights to F 1I)PRN07p27N2004 11 :19 an property belonging to this taxpayer or the amount of these taxes, and additional penalties, interest, and costs that may accrue. Name of Taxpayer RALPH E FLOD 7 Residence 9455 N 1ST AVE 200407494 WOOD RIVER, NE 68883 -1705 Ehe T RELEASE INFORMATION: For each assessment listed below, of the lien is refiled by the date given in column (e), this notice shall, ollowing such date, operai)e as a certificate of release as defined a). Tax Period Date of Last Day fo r Unpaid Balance Kind of Tax Ending Ident ing Number Assessment Refilling of Assessment (a) (b) (c) (d) e) (� 1040 12/31/2000 50860 -0414 02/18/2002 03/19/2012 2241.17 1040 12/31/2002 508160 -0414 06/02/2003 07/02/2013 980.00 Place of Filing Register of Deeds Hall POBOX 1 692 Grand Islan. , NE 68802-1692 This notice was prepared and signed at the 16th day of July 2004 Signature for S KIL,PATRICK ST PAUL, MN Title ACS (80.0) 829 -3903 Total 1$ 3221.17 on this, F' r/ e 29 -00 -0006 (NOTE: Certificate of officer authorized by law to take acknowledgment is not essenuat io are Vdl—Ly — - -- - - Rev. Rul. 71 -466, 1971 - 2 C.B. 409) Form 668(y)(c) (Rev. 2 -2004) Part t - Kept By Recording Office CAT. NO 60025X