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12/24/2003 09:43 FAX 14024714429 NEBRASKA UCC Z004 <br />200310405 <br />1008 <br />Form 566 (Y)(e) <br />Department of the Treasury - Internal Revenue Service <br />:Rev. October 200C, Notice of Federal Tax Lien <br />Brea: Serial Number For Optionel Use by Recording Offica <br />SMALL BUti IN'ESS /SELF EMPLOYED AREA $9 + "t a of stain - uce <br />Lien Unit Phone: (651.) 312 -5050 148550003i�IIIfNHlfilf filurrrra���a ::` <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, 9903381 <br />there is a lien in favor of the United States on all property and rights to F r <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name cf Taxpayer SHAFER INC , a Car -porat:.an <br />Resi:ience 1004 DIERS AV7E STE 300 <br />GRAND ISLAND, Nr_ 68803 -4962 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />urless notice of the lion is refiled by the date given in caiumn (e), this notice shalt, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(a), <br />Tax Period Date of Last Day for <br />Kind of Tax Ending identifying Number Assessment Renting <br />(a) (b) (c). d (e) <br />941 09/30; 20G2 91- X847680 0&/'09 /2003 O7/ 0.0%2013 <br />Piece of Filing <br />Rectister of Deeds <br />Pall POBOX 1692 Total $ <br />Grand Island, NE 61802 -1692e <br />This notice was prepared and signed at ___ S? PAUL, NN <br />the 17th day of Decc- iniaer, 2003 <br />Unpaid Balance <br />of Assessment <br />25263.6:: <br />29269.6; <br />on this, <br />Signature I Title <br />REVE TUE CF. ^TCER <br />fcr MICHAy_.' t30511 384 -6G68. <br />-• 11-1 .. 11 ­'1 1111 ­ veuoity p, lwIX :cc (.r h®08ra1 I aX Ilen <br />Rev, Rui. 71 •4ae, 1971 - 2 C.B. 409) Form 668(Y)(c) {Rev 1G -00; <br />Part I - Kew By Recording Office _ . _ .. _ _ _ . _ _. _ <br />