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09/14/2003 16:56 FAX 14024714429 NEBRASKA UCC 1008 Department of the Treasury - Internal Revenue Seri Form 668 (Y)(c) (Rev_ October 2000) Notice of Federal Tax Lien Area: Serial Number For op? S'MLL BUSINESS /SELF BMPLOXED AREA #9 Lien Unit Phone: (651) 312 -8080 127989203 As provided by section 6321, 6322, and 6323 of the Internal Revenue Code, we are giving a notice that taxes (including interest and penalties) have been assessed against the following -named taxpayer. 'We have made a demand for payment of this liability, but it remains unpaid. Therefore, there is alien in favor of the United States on all property and rights to property belonging to this taxpayer for the amount of these taxes, and additional penalties, Interest, and costs that may accrue. Name of Taxpayer THOMAS A WAGONER Residence 1819 W NORTH FRONT ST GRAND ISLAND, NE 68803 -4706 IMPORTANT RELEASE INFORMATION: For each assessment listed below, unlaR ss notice of the lien Is raffled by the date given in column (e), this notice shall, on he day following such date, operate as a certificate of release as defined in C 6 325(a). Tax Period Date of Last Dayy for IGnd of Tax Ending Identifying Number Assessment lRefiling (a) (b) (c) (d) (e) 941 12/3-1/2002 47- 0550792 06/09/2003 07/09/2013 Place of Filing 2003/005 2003 03;47 OM 200310716 Register of Deeds Hall POBOX 1692 Total $ Grand Island, NE-68802 -1692 This notice was prepared and signed at ST PAUL, MN the 08th day of August 2003 Unpaid Balance of Assessment 141.19 141.19 , on this, Signa-ure / Title f a REVENGE OFF_CER. 29 -10 -1729- for KATHY MALLETT (402) 361 -0250 (NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien Rev. Rul. 71 -466, 1971 - 2 C.B. 409) - - - _ - Form 668(Y)(c) (Rev. 10-00)