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07/30/2004 15:46 FAX 14024714429_ NEBRASKA UCC Q002/003 <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Number I For Optional Use <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (651) 312 -8080 183024704 <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 />there is a lien in favor of the United States on all property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, 'Interest, and costs that may accrue. <br />of Taxpayer TIMOTHY D SKIBSTEAD <br />SK IBSTEAD <br />Filed: 07 <br />ling Office <br />Pus: I <br />12: 01 PM <br />Residence 915 N WHITE 3 <br />GRAM) ISLAND, NE 68803 -4451 <br />E ORTANT RELEASE INFORMATION: For each assessment listed below, <br />s notice of the lien is refiled by the date given in column (e), this notice shall, <br />he day following such date, operate as a certificate of release as defined <br />C 6325(a). <br />Tax Period Date of Last Day for Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment Refiimg of Assessment <br />(a) (b) (c) (d) (e) (f) <br />1040 12/31/1996 505 -94 -0751 02/28/2000 03/30/2010 33773.24 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ 33773.24 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN — , on this, <br />the 22nd day of July 2004 <br />Signature ���`� ACS 29-00 -0008 <br />for S KILPATRICK (800) 829 -3903 <br />(NOTE: Certificate of officer authorized by taw 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) Form 668(Y)(c) (Rev.,2 -2004) <br />D­t t - Vant Rv Rrrerdine Office cnT Nn 60025X <br />