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10/08/2004 15:59 FAX 14024714429 NEBRASKA UCC IM 003/004 200409921 1872 Department of the Treasury - Internal Revenue Service Form 668 (Y)(c) (Rev. February 20041 Notice of Federal Tax Lien Area: Serial Number For Optional Use by Recording Office WAGE & INVESTMENT AREA #5 Lien Unit Phone: ( 800) 829 -7650 1 193751504 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 liability, but it remains unpaid. Therefore, there is a lien in favor of the !United States on all property and rights to property belonging to this taxpayer for the amount of these taxes, and additional penalties, interest, and costs that may accrue. Name of Taxpayer DONALD & CATHLEEN HAUSSERMANN Residence 4954 W HWY 30 7 ALDA, NE 68810 -0025 DONALD 1211111A 04:31 P" LunJe ORTANT RELEASE INFORMATION: For each assessment listed below, s notice of the lien is refiled by the date given in column (e), this notice shall, e day followi ng such date, operate as a certificate of release as defined C 6325(a). Tax Period Date of Last Day for Unpaid Balance Kind of Tax Ending Identifying Number Assessment Refiring of Assessment (a) (b) (c) (d) (e) (f 1040 12/31/2000 505 -72 -4361 08/27/2001 09/26/2011 1876.91 1040 12/31/2003 505 -72 -4361 05/17/2004 06/16/2014 580.14 Place of Filing Register of Deeds Hall POBOX 1692 Total $ 2457.05 Grand Island, NE 68802 -1692 This notice was prepared and signed at the 28th day of September 2004 ST PAUL, MN on this, i Signature Title ACS 15 -00 -0000 for WANDA W. BROWN (800) 829 -7650 (NOTE: 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 668(Y)(c) (Rev. 2 -20041 o.rt i - Kant By Recordin¢ Office rAT rin 80026X