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04/13/2005 16:45 FAX 14024714429 NEBRASKA UCC <br />200503?5f <br />ORQVI <br />Department of the Treasury - internal Revenue Service <br />Form 668 (Y)(c) <br />(Rev. February 20041_ Notice of Federal Tax Lien <br />Q002/002 <br />Area; <br />Serial Number <br />For Optional Use by Recording Office <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (800) 829 -3903 <br />220351305 <br />III Sao of S4N0 - 1K[ FYL <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 ilabi ft, but it remains unpaid. Therefore, <br />there is a lien in favor of the United States on all property and rights to <br />SM53119392 -4 Po,, 1 <br />property belonging to this taxpayer for the amount of these taxes, and <br />MATHMS aprlES a <br />04/1312005 02--24 PM <br />additional penalties, interest, and costs that may accrue. <br />-FL-1-ad; <br />Name of Taxpayer JAMES A MATHEWS <br />Residence PO BOX 1761 <br />GRAND ISLAND, NE 68802 -1761 <br />LEASE INFORMATION: For each assessment listed below, <br />lien is refiled by the date given in column (e), this notice shall, <br />=6325(a). <br />ing such date, operate as a certificate of release as defined <br />Tax Period <br />Date of <br />Last Darr for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refiiing <br />of Assessment <br />a <br />(b) <br />c <br />d) <br />e) <br />f) <br />1040 <br />12/31/1997 <br />304 -44 -1563 <br />12/22/2003 <br />01/21/2014 <br />77441.04 <br />1040 <br />12/31/1998 <br />304 -44 -1563 <br />12/22/2003 <br />01/21/2014 <br />6338.09 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 83779.13 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the 25th- day of March <br />Signature <br />for S KILPATRICK <br />2005 <br />ST PAUL, MN <br />Title <br />ACS <br />(800) 829 -3903 <br />, on this, <br />go 0r - <br />(NOTE: Certificate of officer authorized by taw to take acknowledgment is not essential to the validity of Notice of Federai Tax lien <br />Rev, Rul. 71 -466, 1971 - 2 C.B. 409) `= Form 668(1)W (Rev. 2 -2004) <br />ort 1 - Kept By Recording Office Cg&. NO 60025X <br />