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r 1 `-f 10708/2004 16:00 FAX 14024714429 NEBRASKA UCC Q 004 /004 200409920 This notice was prepared and signed at ST PAUL, MN , on this, n the 28th day of September 2004 l Signature <� 0 4r A''f•�f TTiCtie g If. ar11W�ei«� S 15 -00 -0000 for WANDA W. BROWN 00) 829 -7650 (MOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien Rev. Rul_ 71-466,1971 - 2 C.B. 409) Form 666(Y)(c) (Rev. 2 -2004) 1872 Department of the Treasury - Internal Revenue Service Form 668 (Y)(c) Notice of Federal Tax Lien (Rev. February 2004) Area: Serial Number For Optional Use by Recording Office WAGE & INVESTMENT AREA ##5 Lien Unit Phone: (800) 829 -7650 193751604 Ni S.e .. s +.t. - utc �Yu As provided by section 63211 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 liability, but it remains unpaid. Therefore, there Is a lien In favor of the united States on all property and rights to 9904354085. -0 P9a: HiiU55ERMWNN DONALD P property belonging to this taxpayer for the amount of these taxes, and Filed: 10/0712004 04:31 PM additional penalties, interest, and costs that may accrue. Name of Taxpayer DONALD P HAUSSERMANN Residence 4954 W HWY 30 7 ALDA, NE 68810 -0025 IMPORTANT RELEASE INFORMATION: For each assessment listed below , unless notice of the lien is refiled by the date given in column (e), this notice shall, on the day following such date, operate as a certificate of release as defined in IRC 6325(a). Tax Period Date of Last Dayy for Unpaid Balance Kind of Tax Ending Identifying Number Assessment Refiling of Assessment (a) (b) (c) (d) (e) (f) 1040 12/31/1997 505 -72 -4361 08/13/2001 09/12/2011 1370.49 1040 12/31/1998 505 -72 -4361 06/04/2001 07/04/2011 926.12 1040 12/31/1999 505 -72 -4361 06/04/2001 07/04/2011 2581.57 Place of Filing Register of Deeds Hall POBOX 1692 Total $ 4878.18 Grand Island, NE 68502 -1692 This notice was prepared and signed at ST PAUL, MN , on this, n the 28th day of September 2004 l Signature <� 0 4r A''f•�f TTiCtie g If. ar11W�ei«� S 15 -00 -0000 for WANDA W. BROWN 00) 829 -7650 (MOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien Rev. Rul_ 71-466,1971 - 2 C.B. 409) Form 666(Y)(c) (Rev. 2 -2004)