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05[30/2003 16:33 FAX 14024714429 NEBRASKA L'CC <br />C� <br />Form 666 M(c) <br />IRev. October 2000) <br />200307050 <br />109 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />a 003 003 <br />Area: <br />Serial Number <br />For Optional Use by Recording Office <br />rrr s.. ,r ucc FTL <br />SMALL BUSINESS /SELF EMPLOYED AREA 49 <br />Lien Unit Phone: (800) 829 -3903 <br />390370836 <br />As provided by section 6329, 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 />9903278159 -3 Po><: + <br />there Is a lien In favor of the United States on all property and rights to <br />OFetiv 006N9012003 0Z, 1G PM <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer CANDI L GAFFEY <br />Residence PO BOX 421 <br />WOOD RIVER, NE 68883 -0421 <br />IMP:day NT RELEASE INFORMATION: For each essessment listed below, <br />unles of the lien is refiled by the date given in column (e), this notice shall, <br />on tfollowing such date, operate as a certificate of release as defined <br />in IR (a). <br />Tax Period <br />Date of <br />Last D for <br />Unpaid Balance <br />ICnd of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refi!ng <br />of Assessment <br />a <br />b <br />(c) <br />d) <br />(e ) <br />f <br />1040 <br />12/31/2001 <br />508 -90 -5173 <br />05/03/2002 <br />07/03/2012 <br />14300.05 <br />Place of Filing <br />Register of Deeds Total <br />$ <br />Hall POBOX 1692 <br />14300.05 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at MILWAUKEE, WI on this, <br />the 27th day of May 2003 <br />r , <br />Signatur `_ c Title <br />I' T ^ ACS 27- 00- OOGB� -r' <br />for J GALLAGHER (800) 829 -3903 <br />(NOTE Certificate of officer authorized by law 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 666(Y)(c) (Rev. 10.00) <br />V <br />