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02/16/2005 10:20 FAX 14024714429 NEBRASKA UCC 002 /003 <br />200501348 <br />9303 <br />Department of the Treasury - Internal Revenue Service <br />Form 668 (y)(`) Notice of Federal Tax Lien <br />(Rev. Fabruary 2004) <br />Serial Number For Optional Use by Recording Office <br />Area: - <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 Nt SM .t s+.49 - ucc sn <br />Lien Unit Phone: (651) 312 -8080 213024805 <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, 5i ykie -g pus f <br />there is a lien in favor of the United States on all property and rights to GRl ds 0ARR6fZOes 04:21 an <br />property belonging to this taxpayer for the amount of these taxes, and - <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer LARRY G GRZESS <br />Residence 1507 POST PL <br />GRAND ISLAND, NE 68801 <br />E RTANT RELEASE INFORMATION: For each assessment listed below, <br />otice of the lien is refiled by the date given in column (e), this notice shall, <br />day following such date, operate as a certificate of release as defined <br />6325(a). <br />Tax Period Date of Last Day for Unpaid Balance <br />Kind of Tax Ending - identifying Number Assessment Refilling of Assessment <br />(a) (b) (c) (d) (e) (fl <br />1040 12/31/2003 505 -56 -6424 05/24/2004 06/23/2014 9851.86 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ 9851.86 <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN , on this, <br />the 07th day of February 2005 <br />5(cA <br />Signature AC5 29 -00 -0008 <br />for S KILPATRICK 1 (800) 829 -3903 <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 668(Y)(c) (Rev. 2 -2004) <br />It <br />