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0y9/26/2003 15:34 FAX 14024714429 <br />V 1t <br />NEBRASKA UCC <br />a 003 %003 <br />This notice was prepared and signed at ST PAUL, MN on this, <br />*re 19th day of September 2003 <br />Signature '° Title <br />ACS 29 -00 -0009 <br />Tor S K_ILPATRICK (800) 629 -3903 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential tc the validity of Notice of Federal Tax lien <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 449) Form 668(Y)([) (Rev. 10 -00) <br />.. .. <br />143 <br />1008 <br />Form 668 Y t <br />Department of the Treasury - Irternal Revenue Service � <br />2 U 0 3 2 <br />200o <br />Notice of Federal Tax Lien <br />Fie,- Octoter <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 />135202303 <br />"' is of state • Kr cr <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 />91111111132M 2-8 Pe:: 1 <br />property belonging to this taxpayer for the amount of these taxes, and <br />Filed: 09/251 0 2003 04:17 PM <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer ANNETTE P & DENNIS H COLVIN <br />Residence 412 1/2 W DIVISION <br />GRAND ISLAND, NE 68801 -6512 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the liar, 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 6325fa). <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 />RefiEing <br />of Assessment <br />(a) <br />b <br />c <br />d <br />e <br />f <br />!C40 <br />12/31/2000 <br />506 -72 -7947 <br />04/21/2003 <br />05/21/2013 <br />11473.68 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 11473.68 <br />Grand Island, NE 688D2 -1692 <br />This notice was prepared and signed at ST PAUL, MN on this, <br />*re 19th day of September 2003 <br />Signature '° Title <br />ACS 29 -00 -0009 <br />Tor S K_ILPATRICK (800) 629 -3903 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential tc the validity of Notice of Federal Tax lien <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 449) Form 668(Y)([) (Rev. 10 -00) <br />.. .. <br />143 <br />