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10/09/2003 16:14 FAX 14024714429 Der artment of the Treasury - internal Revenue Service Farm 668 Notice of Federal Tax Lien NEBRASKA UCC Q002/002 Tnis notice was prepared and signed at ST PAL -L,, MINT —)e 02nd day of October 2003 SignaTears .. 3'E��: E " ACS f ^r B STRU13EL (800) 629 --7650 on this, /" V .1s -00 -0000 (NOTE: Certificate of officer authorized by law to take ackncwledp . gent is not essential Tc the ,validity of Notice of Federal Tax iien Rev. Rul. 71 -466, 1971 - 2 C.B. 409) Form 668(Y)(e) (Rev. 10 -CO) 1O, C+� Der artment of the Treasury - internal Revenue Service Farm 668 Notice of Federal Tax Lien 2000) (ass. October zaool Area: Serial Number For Optionai Use by Recording Office Rrt WAGE & INVESTMENT AREA #5 Lien Unit Phone: (800) 829 -7650 137305503 of sa.a - U- 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 foliowing•named taxpayer. We have made a demand for payment of this liability, but it- remains unpaid. Therefore, is to there is a lien in favor of the United States on all property and rights so saes -a property belonging to this taxpayer for the amount of these taxes, and Fa�T.�r`,S101gOB12003 01:11 PM additional penalties, Interest, and costs that may accrue. Name of Taxpayer RUBY A BARTLESON JOHN BARTLESON 200313493 Resioence PO BOX 276 WOOD RIVER, NE 68883 -0276 IMPORTANT RELEASE INFORMATION: For each assessment listed below, unless notice of the lien is refilled by the date given in column (e), this notice shall, on the day following such date, operate as a certificate of release as defined in IRC 6325(a), Tax Period Date of Last Day for Unpaid Balance Kind of Tax Ending Identifying Number Assessment Refilling of Assessment (a) b) (c) (d) (e) f 1040 12/31/1996 506 -62 -2177 10/13/1997 11/12/2007 1040 12/31/2997 506 -62 -2177 09/14/1998 10/14/2008 2454.96 1040 12/31/1998 506 -62 -2177 09/20/1999 10/20/2009 1372,28 --04J 12/31/2001 506 -62 -2177 06/03/2002 07/03/2012 1905.41 Place of Filing Rec'ister of Deeds Hall POBOX 1692 Total $ 5732.65 Grand Island, NE 68802 -1692 Tnis notice was prepared and signed at ST PAL -L,, MINT —)e 02nd day of October 2003 SignaTears .. 3'E��: E " ACS f ^r B STRU13EL (800) 629 --7650 on this, /" V .1s -00 -0000 (NOTE: Certificate of officer authorized by law to take ackncwledp . gent is not essential Tc the ,validity of Notice of Federal Tax iien Rev. Rul. 71 -466, 1971 - 2 C.B. 409) Form 668(Y)(e) (Rev. 10 -CO)