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<br />12/27/2007 THU 14:55 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />200710728 <br /> <br />~005/009 <br /> <br />~ <br /> <br />4653 <br /> <br />Form 668 (Y)( c) <br />(Rev. February 2004) <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice Of Federal Tax Lien. <br /> <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Uen Unit Phone: (800) 913-6050 400965207 <br /> <br />As provided by section 6]2., 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notice that taxes (Including Interest and penalties) <br />have been .assessed alainsa: 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 ripts to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may aceme. <br /> <br />Name of Taxpayer THOMAS A WAGONER <br /> <br />Serial Number <br /> <br />For ODtional Use by Recording Office <br /> <br />\ll"""JI <br /> <br /> <br />9907539895-6 <br />WAGONEd R Jl1m~0~7 11: 65 Al'I <br />File' ,.. <br /> <br />Residence <br /> <br />1819 W NORTH FRONT ST <br />GRAND ISLAND, NB 68803-4706 <br /> <br />IMPORTANT RELEASE INFORMAnON: For each assessment listed below; <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as a cEirtificate of release as defined <br />in IRe 6325(a). . <br /> <br /> Tax Period Date of Last DI for. Unpaid Balance <br />Kind of Tax Ending Identifying Number Assessment . Reftlng of Assessment <br />(a) (b) (e) (d) , (e) en <br />941 09/30/2002 47-0550792 12/30/2002 01/29/2013 52.71 <br />941 09/30/2003 47-0550792 02/16/2004 03/18/2014 91.75 <br />941 12/31/2003 47-0550792 03/29/2004 0'4/28/2014 48.51 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br /> <br />Total $ <br /> <br />192.97 <br /> <br />This notice was prepared and signed at <br /> <br />ST PAUL, MN <br /> <br />, on this, <br /> <br />29th day of October <br /> <br />2007 <br /> <br />the <br /> <br />Signature <br /> <br />Title <br />REVENqE OFFICER <br />for BILL HOUSE (308).532-7510 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien (J <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) . - - .. Form 668(Y)(c) (Rev. 2-2004) .. <br />Part 1 - Kept By Recordin. Offtce CAT. NO 60025X <br /> <br /> <br />24-10-2336 <br />