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11/10/2003 17:32 FAX 14024714429 NEBRASKA UCC <br />J �- V v Department of the Treasury - Internal Revenue Service <br />Form 668 (Y)(c) <br />(Rev. October 2000) Nodce of Federal Tax Lien <br />Area: Serial Number <br />SMALL BUSINESS /SELF EMPLOYED AREA #r9 <br />Lien Unit Phone: (651) 312 -8080 142313803 <br />As provided by sector 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that taxes (including Interest and penakles) <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 Gen 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 wrae. <br />axpayer JERRY L & <br />For <br />1a007/007 <br />200314882 <br />fflce <br />FTL <br />11illil <br />FpftPgx <br />35 PM <br />Residence 205 S CEDAR <br />GRAND ISLAND, NE 68801 -6501 <br />NT RELEASE INFORMATION: For <br />each assessment listed below, <br />of the lien is refiled by the date given In column (e), this notice shell, <br />EIRC <br />following such date, operate as a certificate of release as defined <br />(a). <br />Tax Period Date of <br />Kind a Tax Ending Identifying Number Assessment <br />Last Day for <br />Reffing <br />Unpaid Balance <br />c (d ) <br />of Assessment <br />1040 12/31/1996 505 -52 -3010 12/07/1998 <br />(e) <br />01/06/2009 <br />(f <br />86875.62 <br />1040 12/31/1998 505 -52 -3010 09/27/1999 <br />10/2.7/2009 <br />3428.77 <br />1040 12/31/1999 505 -52 -3010 03/26/2001 <br />1040 12/31/2000 505 <br />C4/25/2011 <br />4592.33 <br />-52 -3010 04/01/2002 <br />1040 12/31/2001 505 -52 -3010 12/09/2002 <br />05/01/2012 <br />01/08/2013 <br />12082.25 <br />8741.90 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ <br />Grand Island, NE 68802 -16.92 <br />This notice was prepared and signed at ST PAUL, MN <br />the 05th day of November 2003 <br />Signature <br />for MICHAEL W PONTE <br />115720.87 <br />, on this, <br />Title <br />REVENUE OFFICER 29 -10 -2337 <br />(308) 384 -6668 <br />ouuucvu <br />Illy law to iaxe acKnowteagment is not essential to the validity of Notice of Federal Tex lien <br />Rev, Rut. 71 -466, 1971 -2 C.B. 4091 <br />Put i - Kept By Recordfrra Office Form 66B(Y)(c) (Rev. 10-00) <br />CAT. NO 60026X <br />