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form tItIY OaO.nmBN of Ipe TreaEUry ~ Inhtnsr flevenee $erviCe _ ,a.,. oecemeer,vfzr Notice of'Fbderal Tax Lien Under Internal Revenue taws: _ Place atfii;ng - register of Deeds ~ - County of Hall Total!i 705568 Grand Island, Nebraska 68801 Thisnoticewaspreparedandsignedat Grand Island Nebraska ;on this,, the 2nd day of Februar fg 84 Sipnatu -_ - ~ ~ Titie Lyle. Metager Revenue Officer Ceeffimte of officer authorized by 4ow ro rake ocknowtedgernents 75 no+ essentiol ro the validity of Notice of Federal Tax Uerz - 2ti414, 195c-i, C.B. 125.1 Form 861 ia.v. 12A]) Part 1 - To be kept by recording. office U "" "' - - Diaurct SedalNUmber ForOptlonakUSebyRecprdtngOffice - Omaha 47 46531 ps provided by sections 6821, 8322, and 11323 of the Internal Revenue-Code, notice is-given ' - that taxes-(inc4uding interest-and penalties} have been a6sessedagainat the~following•named- , ' - taxpgyer. Demand `for payment of thts- IiebllHy has :been made; but it remains unpsitl: ~~ /+ p p i Therefore. there is a lien in favor of ttre United States aft alt property and rights to proP,ertY O ~ w~~~~ U ~DO 1 beidnging to this taxpayer for the amount of these~faxes, and additional penalties, interest, ~ Q - andtcosts that may accrue. - - - Name ofllaxpayer ~ - - _ - - Clayton Petersen Inc. (a corporation) Resieence 373 North Vine _ - - - - G=and Island, Nebraska 68801 -IMROf1TANT RELEASE-lNFfJRMATtOfi-~Withrespect-to each assessment listbelow,-unless-notice of Bemis-refited~.6y~the'•date: givenancolumn (e), ihts notice shalt; omthe day following-such-date, operate as-~a=certltlcate of-release asdeRned in IRG 8325 is?~ - - - - _ - Tax Period. Dateot LsstDRY-1o- UnWWraalrnon Kind°ot.Taz> Prided:, identifying Number Assesenlent MHlinpp of AeaeeefrreM °) (41 (~ (dl f°~ f0 941 - O1 12-31-81 BMF 47_0524422 12-OS-83 01.04-90 2973.68 . 941 - O1 12-3I-83 02-O1-84 03-02-90 3691.00. 940 - LO 12-31-83 02-01-84 03-02-90 391.0,0""