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09/29/2003 10:41 FAX 14024714429 NEBRASKA UCC <br />10 <br />Form 666 M(c) (Rev. October 2000) <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 <br />Lien Unit Phone: (651), 312 -8080 135615103 <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 Item 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 KATHLEEN Y JOHNSON <br />For Optional Use <br />1a002/002 <br />:cording Office <br />FTL <br />f3K00:37 PA <br />Residence 1620 W JOHN ST <br />GRAND ISLAND, NE 68801 -6323 200319 <br />IMPORTANT RELEASE INFORMATION. For each assessment listed below, <br />unless notice of the lien is refiled <br />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 />Tax Period <br />Date of Last Day for <br />unpaid Balance <br />Kind of Tax Ending <br />Identifying Number Assessment Refilling <br />of Assessment <br />(a) (b) <br />{c d (e ) <br />(f <br />940 <br />12/31/2002 <br />47- CB45809 <br />09/08/2003 <br />10/08/2013 <br />389.64 <br />941 <br />06/30/2002 <br />47- 0845809 <br />02/03/2003 <br />03/05/2013 <br />5424.36 <br />941 <br />09/30/2002 <br />47- CB45809 <br />09/08/2003 <br />10/08/2013 <br />6355.62 <br />941 <br />12/31/2002 <br />47- 0845809 <br />06/23/2003 <br />07/23/2013 <br />2496.80 <br />Place of Filing <br />Register of Deeds <br />Hall. P03OX 1692 Total $ 14666.42 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PATTL, MN on this, <br />the 23rd day of September 2003 <br />Si =nature { , F. h, � X "f Title <br />e � REVENUE OFFICER <br />fc:r KAY PONTE (308; 384 -6667 <br />r� <br />( <br />( -.:. r.. <br />29 -10 -2339 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of = •dcral Tax 1,0n <br />Rev. Rul. 71 -486, 1971 - 2 C.B. 4109) Form 668(7)(c) (Rev. 10 -00) <br />_ .. ... - °- - -- .tee..._ nsa.. -. _ . � .... ......... ... <br />