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t. v' 01/26/2005 17:08 FAX 14024714429 NEBRASKA UCC IM 004/006 J 9303 Department of the Treasury - Internal Revenue Service {Rev. February 20044) l Form 668 (Y) Notice of Federal Tax Lien 20050069 Area: Serial Number For Optional Use by Recording Office SMALL BUSINESS /SELF EMPLOYED AREA #9 Lien Unit Phone: (651) 312 -8080 209772105 NE s.W of 54.40 - UCC FTL As provided by section 6321, 6322, and 6323 of the Internal Revenge Code, we are giving a notice that taxes (including interest and penalties) have been assessed against the following -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 ss ®sass sa-e -pas: I property belonging to this taxpayer for the amount of these taxes, and FiiedI 01/26/2005 10:32 AN additional penalties, interest, and costs that may accrue. Name of Taxpayer KEITH J MCTAVISH Residence PO BOX 411 WOOD RIVER, NE 68883 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). Tax Period Date of Last Day for Unpaid Balance Kind of Tax Ending Identifying Number Assessment Refiling of Assessment a) (b) (c) (d) (e) (f) 1040 12/31/2001 508 -78 -1693 12/09/2002 01/08/2013 29072.94 1040 12/31/2002 508 -78 -1693 04/28/2003 05/28/2013 18013.37 Place of Filing Register of Deeds Hall POBOX 1692 Total $ 47086.31 Grand Island, NE 68802 -1692 This notice was prepared and signed at the 18 th day of January 2005 ST PAUL, , MN , on this, Signature Title CASE PROC MGR 29 -98 -6901 for BETTY BUCHAN (651) 312 -7836 (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 1 - Kept By Recording Office Form 668(lt CAT (Rev. 2-2 CAT. NO 60025X 5X J This notice was prepared and signed at the 18 th day of January 2005 ST PAUL, , MN , on this, Signature Title CASE PROC MGR 29 -98 -6901 for BETTY BUCHAN (651) 312 -7836 (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 1 - Kept By Recording Office Form 668(lt CAT (Rev. 2-2 CAT. NO 60025X 5X J