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03/01/2010 MON 15:27 FAX 402 471 4429 [ICC SECRETARY OF STATE ~yy Hall ~• ' 3592 pepartment of the Treasury -Internal Revenue Service Form bb8 (Y)(c) Notite of Federal Tax Lien lRev. February 20041 Ia1006/008 A a: Serial Number For Optional Use by Recording Office re SMi~iLL BUSINESS/SELF EMPLOYED AREA #4 Lien Unit Phone: (B00) 913--6050 626323610 As provided by section b321, b322, and b323 of the Internal Revenue NE Sao of f!e!e Jokn A 6N• - UCC FTl 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 far 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 property belonging to this taxpayer for the amount of these taxes, and 991062111'-~ Pss: 1 YOST RRNDELL J additional penalties, interest, and costs that may accrue. ~ Fit4d: maie,iam,0 t0:4~ Rm Name of Taxpayer RANDELL J YOST ~oiooi33s Residence 1 p 14 N WASHINGTON ST GRAND ISLAND, NE 68$01-4041 IMPORTANT RirLi+AS~ INFORA~ATION: For each assessment listed below, unless notice of the lien is raffled by the date given In column (e), this notice shall, on the day fallowing such date, operate as a certificate of release as defined in IRC 6325(al. Tax Period Date of Last Dayy for unpaid Balance Kind of Tax finding. Identifying Number Assessment Refiling of Assessment a b) (c (d) e) (f) -1040 12/31%2001 XXX-XX-1434 07/30/2007 08/29/2017 11305.72 1.040 12/31/2003 XXX-XX-1434 07/30/2007 08/29/201.7 1924.03 Place of Filing Register of Deeds Hall POBOX 1692 Total $ Grand Island, NE 58802-1692 13229.75 This notice was prepared and signed at CHICAGO, IL the 17th day of February 2010 on this, Signature ~ A ~~~ Title REVENUE OFFICER 24-10-1744 for PATRICK J KELLOGG (308) 384-4850 Rev. Rul. 71-466, 1971 - 2 C.B. 409) Form bb8(ln(c) (Rev. 2-2004) Part 1 -Kept By Recording Office CAT. NO fi0025x ~ .