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<br />07/15/2008 TUE 13:32 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />1210101014 <br /> <br />OJ <br /> <br />, 200-806116 <br /> <br />4653 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />Form 668 (Y)(C) <br />(Rev. February 2004) <br /> <br />Area: Serial Number <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 454966808 <br /> <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, <br />there is a lien in favor of the United States on all propertY and rights to <br />property belonaine to this taxpayer for the amount of these taxes, and <br />additional penalties, ,interest, and costs that may accrue. <br /> <br />Name of Taxpayer TODD W & LORI FRIBSEN <br /> <br />For Optional Use by Recording Office <br /> <br />\\11111111'1 <br /> <br /> <br />9908565706-1 Pa . <br />~n~~N0~~~gJ~008 11:35 AM <br /> <br />, Residence <br /> <br />4134 W FAIDLEY AVE <br />GRAND ISLAND, NB 68803-3327 <br /> <br />IMPORTANT RELEASE INFORMATION: 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 certificate of release as defined <br />in IRe 6325(a). <br /> <br />Kind of Tax <br />(a) <br />1040 <br />1040 <br /> <br />Tax Period' <br />Ending <br />(b) <br />12/31/2003 <br />12/31/2006 <br /> <br />Identifying Number <br />Cd <br />XXX-XX-6717 <br />XXX-XX-6717 <br /> <br />Date of <br />Assessment <br />(d) <br />08/01/2005 <br />12/03/2007 <br /> <br />Last Day for <br />, Retinng <br />(e) <br />08/31/2015 <br />01/02/2018 <br /> <br />Unpaid Balance <br />of Assessment <br />(0 <br />1115.06 <br />39870.18 <br /> <br />t~: <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 />40985.24 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />, on this, <br /> <br />the <br /> <br />03rd day of July, <br /> <br />2008 <br /> <br />Signature <br /> <br /> <br />Title <br />ACS <br />(800) 829-3903 <br /> <br />24-00-0008 <br /> <br />for REGINA OWENS <br /> <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71-466, 1971 .2 C.B. 409) Form 66BCY)CclIRev. 2-2004) \ ,J <br />