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` 05/20/2005 16:26 FAX 14024714429 NEBRASKA UCC 0005/005 <br />(0 q <br />Form 668 (Y)(0 <br />FR—, FAhruary 2004) <br />200504604 <br />5303 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: Serial Number <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 227153005 <br />Lien Unit Phone: (800) 913 -6050 <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 />Name of Taxpayer TERI L GASARES <br />Residence 910 N BOGGS AVE APT S01 <br />GRAND I S LAND , NE 68803-4424 <br />IMPORTANT RELEASE INIFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />For Optional Use b, <br />U7Tice <br />H9 &or or 54.4:. - XC FTL <br />I <br />i <br />CASARES Filsdi m8 20120ae 00;21 aM :: 1 <br />Kind of Tax <br />Tax Period <br />Ending <br />Identifying Number <br />Date of <br />Assessment <br />Last Dar�rr for <br />Refiling <br />. Unpaid Balance <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />W- <br />1040 <br />12/31/1999 <br />507 -94 -4945 <br />06/24/2002 <br />07/24/2012 <br />2258.91 <br />1040 <br />12/31/2000 <br />507 -94 -4945 <br />06/24/2002 <br />07/24/201.2 <br />3202.66 <br />Place of Filing <br />Register of Deeds <br />Hail POBOX 1692 Total $ 5461.57 <br />Grand Island, NE 68802 -1.692 <br />This notice was prepared and signed at <br />5T PAUL, MN _ , on this, <br />the 09th day of May 2005 <br />Signature ACS 2 9- 0 0- D D O B <br />(800) 829 -39D3 <br />for S KILPATRICK <br />(NOTE: Certificate of officer authorized by law to take aclmowfedgment is not essential to the validity of Notice of Federal Tax lien <br />�, &a 1 071 _ r R 4041 Form 669(1)([) (Rev. 2 -2004? <br />