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05/06/2008 TUE 14:23 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall tilI006/007 ~ 1924 Department of the Treasury - Internal Revenue Service Notice of Federal Tax: Lien 20 0 8 0 3 90 5 Form 668 (Y)( c) (Rev. Februarv 20041 Area: Serial Number SMALL BUSINESS/SELF EMPLOYED AREA #4 Lien Unit Phone: (800) 829-3903 440821208 As provided by section 6321, 6322, and 6323 of the Internal Revenue Code, we are sivina a notice that taxes (including Interest and penalties) have been assessed against the followll1l~named taXPayer. We have made a demand for payment of this liability, but it remains unpaid. Therefore, there is a lien In favor of the United States on all property and rights to property belontlng to this taxpayer for the amount of these taxes, and additional penalties, Interest, and costs that may accrue. Name of Taxpayer GEORGE W & DONNA R PETERSON For Optional Use by Recording Office 11:llIllllrl~ 'I 9908558733-9 Pgs: 1 PETERSON GEORGE W Filed, 05/06/2008 10,29 AM Residence 1918 N GRAND ISLAND AVE GRAND ISLAND, NE 68803-2740 IMPORTANT RELEASE INFORMATION: For each assessment listed below, unless notice of the lien is refiled 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). Kind of Tax (a) 1040 1040 Tax Period Ending eb) 12/31/2'005 12/31/2006 Identifying Number (c) XXX-XX-7091 XXX-XX-7091 Date of Assessment (d) 11/06/2006 11/05/2007 Last D~ for -Reftling ee) 12/06/2016 12/05/2017 Unpaid Balance of Assessment (f) 12179.79 2717.10 Place of Filing Register of Deeds Hall POBOX 1692 Grand Island, NE 68802-1692 Total $ 14896.89 This notice was prepared and signed at CHI CAGO , IL , on this, 24th day of April 2008 the Signature Title ACS (800) 829-3903 24-00-000~ for REGINA OWENS (NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien Rev. Rul. 71-466,1971 - 2 C.B. 409) Part t . Kept By Recording OftIce Form 66B(Y)(e) (Rev. 2-20041 CAT. NO 60025X \;