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06/14/2005 08:27 FAX 14024714429 NEBRASKA UCC <br />1872 <br />Department of the Treasury - Internal Revenue Service <br />Form 668 (n(c) Notice of Federal Tax Lien <br />(Rev_ February 2004) <br />Q003/006 <br />200505364 <br />Area: <br />Serial Number <br />For Optional Use by Recording Office <br />FTL <br />SMALL BUSINESS /SELF EMPLOYED AREA 49 <br />Lien Unit Phone: (800) 913• -6050 <br />231226105 <br />WE iea ar 5���■ - U C <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 />ilil <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 />990539a9s3 -a ass 1 <br />property belonging to this taxpayer for the amount of these taxes, and <br />Ft�ied: 06113E 008 10:43 PA <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer JEFFREY GREENWALT <br />Residence 4320 MANCHESTER <br />GRAND ISLAND, NE 68803 <br />RELEASE INFORMATION: For each assessment listed below, <br />e lien is refiled by the date given in column (a), this notice shall, <br />=foliowing <br />g such date, operate as a certificate of release as defi ned <br />Tax Period <br />Date of <br />Last Day for <br />unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refiring <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />a <br />f) <br />940 <br />12/31/2004 <br />47- 0844115 <br />05/09/2005 <br />06/08/2015 <br />665.61 <br />941 <br />06/30/2004 <br />47- 0844115 <br />01/03/2005 <br />02/02/2015 <br />338.06 <br />941 <br />09/30/2004 <br />47- 0844115 <br />01/03/2005 <br />02/02/2015 <br />11414.37 <br />941 <br />12/31/2004 <br />47- 0844115 <br />05/09/2005 <br />06/08/2015• <br />13352.61 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 25770.65 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at <br />the <br />03rd day of June <br />2005 <br />ST PAUL, MN <br />, on this, <br />Signature Title <br />REVENUE OFFICER 29 -10 -2339 <br />for KAY PONTE (308) 384 -6667 <br />(DOTE: Certificate of officer authorized by law to rake acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 4091 _Y Form 668(Y)(c) (Rev. 2 -2004) P <br />