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03/04/2005 16:29 FAX 14024714429 NEBRASKA <br />W- <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />200501952 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Serial Number For Option <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #9 215506305 <br />Lien Unit Phone: (651) 312 -8080 <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 penaltles) <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 belonging to this taxpayer for the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer THOMAS P METTENBRINK <br />IM 004/005 <br />Use by Hecoramg Unite <br />W S� of 94nUCCl��lln <br />Pas: 1 <br />Filed; 03 1 6312MS 04:12 PM <br />Residence 1324 W NORTH FRONT ST <br />GRAND ISLAND, NE 68801 -4748 <br />ANT RELEASE INFORMATION: For each assessment listed below, <br />ice of the lien is refiled by the date given in column (e), this notice shall; <br />y following such date, operate as a certificate of release as defined <br />EIR <br />25(a). <br />Tax Period <br />Date of <br />La st Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refilling <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />940 <br />12/31/2001 <br />47- 0758534 <br />07/26/2004 <br />08/25/2014 <br />172.66 <br />941 <br />09/30/2001 <br />47- 0758534 <br />04/07/2003 <br />05/07/2013 <br />3367.13 <br />941 <br />12/31/2001 <br />47- 0758534 <br />04/07/2003 <br />05/07/2013 <br />2338.27 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total $ <br />Grand Island, NE 68802 -1692 <br />This notice was prepared and signed at ST PAUL, MN <br />the 2 3 rd day of February 2005, <br />5878.06 <br />on this, <br />r <br />C�5 <br />Signature REVENUE OFFICER 29 -10 -2337 <br />for MICHAEL W PONTE 1 (308) 384 -6668 <br />(Noll. uerpncate or omcer auznonLcU vy ,—. L. 1— - <br />Rev. Rul. 71- 466,'1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2 -2004) <br />Port i - Kelm Rv Recordine Office r AT NC) R0025X <br />If <br />