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09 <br />06/14/2005 08:26 FAX 14024714429 NEBRASKA UCC <br />Form 668 (Y)(c) <br />(Rev. February 2004) <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 2312.26005 <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 />ame of Taxpayer JEFF <br />T <br />Residence 810 E 4TH <br />GRAND ISLAND, NE 68801 -2706 <br />16002/006 <br />200505363 <br />For Optional Use by Recording Office <br />NQ C.- .f fi W e - UCC FTL <br />i <br />9905398982 -6 P85; 1 <br />GREEN4ALT JEFF A <br />Fllsd; 06/1312006 W43 AM <br />IMPORTANT RELEASE INFORMATION: 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, <br />operate as a Certificate of release as defined <br />in IRC 6325(a). <br />Kind of Tax <br />Tax Period <br />Ending <br />Identifying Number <br />Date of <br />Assessment <br />Last Day for <br />Refilmg <br />a) <br />(b <br />'(c <br />(d) <br />(e) <br />941 <br />03/31/2001 <br />47-0755710 <br />12/06/2004 <br />01/05/2015 <br />941 <br />06/30/2001 <br />47- 0755710 <br />12/06/2004 <br />01/05/2015 <br />941 <br />09/30/2001 <br />47- 0755710 <br />12/06/2004 <br />01/05/2015 <br />Place of Filing <br />Register of Deeds <br />Hall POSOX 1692 Total $ <br />Grand island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN <br />the 03rd day of June 2005 <br />Unpaid Balance <br />of Assessment <br />5513.10 <br />10532.73 <br />9808.09 <br />25853.92 <br />, on this, <br />Signature Title 29-10-2339 <br />REVENUE OFFICER <br />for KAY PONTE (308) 384 -6667 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />l4ev. Rul. 71-466,1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2 -20041 <br />r A-r kin FnnoFY <br />