Free Declaration - District Court of Colorado - Colorado

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 1 of 13

EXHIBIT
1

439.1

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 2 of 13

United States

of America

Department of the Treasury

Internal Revenue Service
Date: Feb. 7, 2007

CERTIFICATE OF OFFICIAL RECORD

I certify that the annexed: is a tre Form 4340, Certficate of Assessments, Payments and
Other Specified Matters for Frederick J. Klodt, SSN: for Civil Penalty, for the tax

period ending December 31, 1999, consisting of eleven pages

IN WITNESS WHEREOF, I have hereunto set my hand, and caused the seal of this office to be affixed, on the day and year first above written.

~ il
Midge Ward
SW Delegation Order 198
Catalog Number 19002E

By direction of the Secretary of the Treasury:

Supervisor Accounting Techncian
Ogden W &1 Submission Processing

Form 2866 (Rev. 09-1997)

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 3 of 13

- - - - - - ---- - - ---- - - - - - - - - - ----- - - - - - - - - - - - -- - - - -- - - -- - - -- -- -- - - - - -- - - - - -- -- - - - - --

CERT IF ICA TE OF ASSESSMENTS. PAYMENTS. AND OTHER SPEC IF lED MATTERS

FREDERICK J KLODT EIN/SSN:
FORM: CVPN TAX PER I OD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENALTY

ASSESSMENT, PA YMENT . ASSESSMENT OTHER DEBITS CRED I T DATE (23C. (REVERSAL)- - -- -(REVERSAL) - - ----- - - 006 ) -RAC --- - - - - - - - ----- -- - - ---- - - - -- - ------ -- - - - - - - - - ---- - - - - - --------

EXPLANATION OF TRANSACTION

MISCEllANEOUS PENAL TY IRC 6672 - TRUST FUND
RECOVERY PENAL TY

553.674.21

12-24-2001

29254-737-52002-1 00000008
ADDITIONAL TAX ASSESSED 29254-737-52002-1 00000008
11-28-2001 XREF 100Y. PENALTY
o . 00

12-24-2001

84- 0 736920
84- 0 736 920 84- 0 736 920

941 199903

,.r

11-28-2001 XREF 100Y. PENALTY

941 199906

11-28-2001 XREF 100Y. PENAL TV

941 199909

11-28-2001 XREF I00Y. PENALTY

84- 0 736920
11-28-2001

941 199912

11-28-2001

FORM 4340 (REV. 01-2002)

PAGE

1

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 4 of 13

- -- -- - - - - - - - -- - - -- - - - - - - - -- - -- - - - - - - - - - - - - - - - -- - - -- - - - - - - - -- -- - - - - - - - - - -- - - - - - --

CERT IF I CA TE OF ASSESSMENTS . PAYMENTS. AND OTHER SPEC IF lED MATTERS

FREDER ICK J KLODT E IN/SSN:
FORM: CVPN TAX PERIOD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENALTY

EXPLANATION OF TRANSACTION

-- -- -- --- - -- - --- - ---- - - - - -- - - - - - - - - -11-28-2001 11-28-2001 11-28-2001 11-06-2000
XREF 100Y. PENALTY

ASSESSMENT. OTHER DEBITS -- --(REVERSAL) - --- - - - --

CREDIT (REVERSAL)------ -- --- - --

PAYMENT.

DATE (23C. -- - RAC-006-)------ - -

ASSESSMENT

199912

100Y. PENALTY

199912

100Y. PENALTY

199909

IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED BUSINESS

MISCELLANEOUS PENAL TY ADJUSTMENT

55.8808

29254-431- 530 0 0-2

11-28-2001

100Y. PENALTY

199912

02-12-2002

ADJUSTMENT

MISCELLANEOUS PENALTY
IRC 6672 TRUST FUND

10.281.47-

RECOVERY PENALTY /RELA TED

89254-463- 530 0 0-2

BUSINESS

08

01-11-2002

IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT
89254-473- 530 04-2

ADJUSTMENT

MISCELLANEOUS PENALTY

425.2508

FORM 4340

(REV.

01-2002)

PAGE 2

/'

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 5 of 13

- - - - - -- - - - - - - - -- - - -- - - - - -- - -- - - - - - - ---- - - ---- - -- -- - --- - - - -- - - -- - - - -- ------ - - - - --

CERT I FICA TE OF ASSESSMENTS . PAYMENTS, AND OTHER SPEC IF lED MATTERS

FREDER ICK J KLODT E I N/SSN:
FORM: CVPN TAX PERIOD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENAL TY

ASSESSMENT. PA YMENT . ASSESSMENT OTHER DEBITS CREDIT DATE (23C. (REVERSAL) - - - - - - - - - - - - - - - - - - RAC 006-)- -(REVERSAL) - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -------

EXPLANATION OF TRANSACTION

01-11-2002 MISCELLANEOUS PENALTY
IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT
04-15-2002 MISCELLANEOUS PENAL TY
ADJUSTMENT ADJUSTMENT

425.25-

29254-537-53002-2 08

5.299.00-

IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT

29254-537-53042-2 08
MISCELLANEOUS PENALTY IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED
PERSONAL CREDIT

425.25

01-11-2002

29254-578-53005-2 00000008
IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT 29254-578-53014-2 00000008
MISCELLANEOUS PENAL TY

5.299.00

04-15-2002

MISCELLANEOUS PENALTY IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT 29254-605-53006-2 00000008

425.25

01-11-2002

03-03-2003 MODULE IN FEDERAL PAYMENT LEVY PROGRAM 03-10-2003 OVERPAID CREDIT APPLIED

1040 200212

713.00

03-10-2003 XREF 100Y. PENALTY

84-0736920

941 199003
PAGE
3

FORM 4340 (REV. 01-2002)

-I

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 6 of 13

CERTIFICATE - -- -- ---- - ------ - --- - OF- - ---- - -- - - ---- PAYMENTS. ---- -- - - -- -SPECIFIED -MATTERS - - - - --- ASSESSMENTS. - - - - - -- - AND OTHER - - --- - - - -- ---- --

FREDERICK J KLODT EIN/SSN:
FORM: CVPN TAX PER IOD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENALTY

ASSESSMENT. PA YMENT . ASSESSMENT EXPLANATION OF TRANSACTION OTHER DEBITS CREDIT DATE (23C. RAe - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (REVERSAL)- - - - -(REVERSAL) - - - - -- - - - 006 -)- ------------------

11-17-2003 12-01-2003

PROGRAM

MODULE REVERSED OUT OF FEDERAL PAYMENT LEVY

MODULE BLOCKED OR RELEASED FROM FEDERAL PAYMENT LEVY PROGRAM

04-15-2003

MISCELLANEOUS PENALTY
ADJUSTMENT
RECOVERY PENAL TY /RELA TED

17.322.0008

IRC 6672 TRUST FUND

PERSONAL CREDIT

83254-750 - 53057- 3
199912

11-28-2001

XREF 100Y. PENAL TY

04-15-2003

MISCELLANEOUS PENALTY
IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT
ADJUSTMENT

5.050.0008

83254-756 - 53026~ 3

11-24-2003

ADJUSTMENT

MISCELLANEOUS PENALTY

1.689.9808

IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT

83254-449-53172-4
02-27-2004
FORM 4340

OFFER IN' COMPROMISE PENDING

(REV.

01-2002)

PAGE 4

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 7 of 13

- - - - -- - - -- -- - - -- - -- - - - - - -- - - - - - - -- - - - - - - - - - - - ---- - --- - - -- - - -- - --- - - - - - - -- - - -- - --

CERT I FICA TE OF ASSESSMENTS. PAYMENTS. AND OTHER SPEC IF lED MATTERS

FREDERICK J KLODT EIN/SSN:
FORM: CVPN TAX PER IOD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENALTY

-------------------------------------------------------------------------------05-04-2004 OFFER IN COMPROMISE REJECTED

EXPLANATION OF TRANSACTION

ASSESSMENT. OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL)

PA YMENT.

ASSESSMENT

DATE (23C. RAC 006 )

05- 0 7-20 04 FEDERAL TAX LIEN
05-31-2004 FEES AND COLLECTION COSTS
05-31-2004 REVERSAL OF MODULE BLOCKED FROM FEDERAL PAYMENT LEVY PROGRAM

42.00

05-31-2004 OVERPAID CREDIT APPLIED

1040 200312

42.00

04-15-2004 OVERPAID CREDIT APPLIED

1040 200312

2.730.00
0.26

05-31-2004 INTEREST OVERPAYMENT CREDIT

1040 200312

04-15-2004 MISCELLANEOUS PENALTY
ADJUSTMENT
RECOVERY PENAL TY /RELA TED

10.734.00-

IRC 6672 TRUST FUND

PERSONAL CREDIT

83254-569-53083-4 08

07- 05- 20 04 MODULE BLOCKED OR RELEASED FROM FEDERAL PAYMENT LEVY PROGRAM

FORM 4340 (REV. 01-2002)

PAGE

5

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 8 of 13

CERT - - -- - - -- - - - IF-ICA TE OF ASSESSMENTS - PAYMENTS. AND OTHER - - - - -- - -- --- - - ----- - - - - --- - --- - ---- - --- - - - - - -- . - - ---- -- - - -- -- - ---- - SPEC IF lED MATTERS

FREDER ICK J KLODT E IN/SSN
FORM: CVPN TAX PERIOD: DEC 1999
DATE

TYPE OF TAX: CIVIL PENALTY

RAC 006 ) --------------------------------------------------------------------------------

EXPLANATION OF TRANSACTION

ASSESSMENT. OTHER DEBITS ( REVERSAi)

CREDIT (REVERSAL)

PA YMENT .

ASSESSMENT

DATE (23C.

06-15-2004 COLLECTION DUE PROCESS
EQU IVALENT HEAR ING REQUEST RECE IVED

06-19-2004 INTENT TO LEVY COLLECTION DUE PROCESS NOTICE LEVY NOTICE ISSUED 07-20-2004 INTENT TO LEVY COLLECTION DUE PROCESS NOTICE RETURN RECE IPT SIGNED 04-15-2005 OVERPAID CREDIT APPLIED

1040 200412

934.00

06-18-2005 COLL DUE PROCESS EQVLNT HEARING RSLVED BY APPEALS DECISION L TR ISSUED BY TXPYR WTHDRW HEARING RQST 04-15-2005 MISCELLANEOUS PENALTY
ADJUSTMENT
RECOVERY PENAL TY /RELA TED

5.160.00-

IRC 6672 TRUST FUND

PERSONAL CREDIT

83254-642-53005-5 08
ADDITIONAL TAX ASSESSED 17254-686-05267-5 00000008
o . 00
PAGE
6

10-31-2005

FORM 4340 (REV. 01-2002)

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 9 of 13

--- - - - - ------ - - -- - - --- - - - - - - - - ---- - ---- -- - - - -- - - - - - - - - - - - - -- ---- - - - ---- - - - - -- - --

CERTIF ICATE OF ASSESSMENTS. PAYMENTS. AND OTHER SPECIF lED MATTERS

FREDER ICK J KLODT E IN/SSN:
TYPE OF TAX: C iv i L PENAL TY

FORM: CVPN TAX PERIOD: DEC 1999
DATE

EXPLANATION OF TRANSACTION

- - --- -- -- ----- - - --- - - - - - - -------- - ---- -- - - ---- - - - - - - --10-31-2005 REVERSAL OF MODULE BLOCKED FROM FEDERAL PAYMENT LEVY PROGRAM

ASSESSMENT. OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL) -------- - - -

PA YMENT .

--

DATE (23C. RAC 006 - - --- -- -- )

ASSESSMENT

--

06-08-2004 LEGAL SUIT PENDING
06-16-2005 MISCELLANEOUS PENAL TY
ADJUSTMENT

7.678.00-

IRC 6672 TRUST FUND RECOVERY PENALTY /RELATED PERSONAL CREDIT

29254-692-53106-5 08
06-28-2005 MISCELLANEOUS PENALTY
ADJUSTMENT

30.000.00-

IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT

29254-692-53107-5 08
06-18-2005 LEGAL SUIT NO LONGER
PENDING

11-07-2005 MODULE IN FEDERAL PAYMENT LEVY PROGRAM
11-25-2005 RECEIVED POA/TIA
IRC 6672 TRUST FUND RECOVERY PENAL TY/RELATED BUSINESS 29254-749-53209-5 00000008
ADJUSTMENT

MISCELLANEOUS PENAL TY

55.88

11-06-2000

04-15-2005 MISCELLANEOUS PENALTY 11.435.00IRC 6672 TRUST FUND RECOVERY PENAL TY/RELATED PERSONAL CRED I T

29254-749-53211-5 08

FORM 4340 (REV. 01-2002) PAGE 7

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 10 of 13

-- - - - - - - - -- - -- - - - - - - -- - - -- - -- - - - -- -- - --- - - - -- - - -- - -- -- -------- - - - - -- - - - -- -- - - ---

CERT IF ICA TE OF ASSESSMENTS . PAYMENTS. AND OTHER SPEC IF lED MATTERS

FREDERICK J KLODT EIN/SSN:
TYPE OF TAX: CIVIL PENALTY

FORM: CVPN TAX PERIOD: DEC 1999
DATE

ASSESSMENT. PA YMENT. ASSESSMENT OTHER DEBITS CREDIT DATE (23C. (REVERSAL)- - - - -(REVERSAL) - - - - - - - - -- - - -)- -RAC 006 ----------------------------------------------------------

EXPLANATION OF TRANSACTION

08-18-2005 MISCELLANEOUS PENALTY
ADJUSTMENT

35.000.00-

RECOVERY PENALTY /RELA TED PERSONAL CREDIT

IRC 6672 TRUST FUND

29254-749- 53215- 5 08
01- 02- 20 06 MODULE REVERSED OUT OF FEDERAL PAYMENT LEVY
PROGRAM

02-06-2006 MODULE BLOCKED OR RELEASED FROM FEDERAL PAYMENT LEVY PROGRAM
05-03-2006 OFFER IN COMPROMISE
PENDING

11-06-2000 MISCELLANEOUS PENAL TY
ADJUSTMENT
RECOVERY PENAL TY /RELA TED

55.88-

IRC 6672 TRUST FUND

29254- 552- 53125-6 08
MISCELLANEOUS PENALTY IRC 6672 TRUST FUND RECOVERY PENALTY/RELATED PERSONAL CREDIT 81254-551-53329-6 00000008
ADJUSTMENT

BUSINESS

35.000.00

08-18-2005

08-18-2005 MISCELLANEOUS PENALTY 35.000.00RECOVERY PENAL TY/RELATED PERSONAL CREDIT

IRC 6672 TRUST FUND

83254-551-53110-6 08

FORM 4340 (REV. 01-2002) PAGE 8

..

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 11 of 13

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CERT IF ieA TE OF ASSESSMENTS . PAYMENTS. AND OTHER SPEC IF lED MATTERS

FREDER ICK J KLODT E IN/SSN:
TYPE OF TAX: CIVIL PENALTY

FORM: CVPN TAX PERIOD: DEC 1999
DATE

EXPLANATION OF TRANSACTION

- - - - - - - -- - - - -- - - ----- - - - - ---- - - --- -- - - -

ASSESSMENT. OTHER DEBITS - -(REVERSAL)- -- - - --- - -

CREDIT (REVERSAL) --- - - ----- -- -

PAYMENT.

DATE (23C. -- - - RAC -006 )- --- -- - --

ASSESSMENT

04-15-2006

MISCELLANEOUS PENAL TY ADJUSTMENT

18.091.00-

RECOVERY PENALTY/RELATED PERSONAL CREDIT
83254- 551-53112- 6

I RC 6672 TRUST FUND

08

05-31-2006

UPDATED POA/TIA
IRC 6672 TRUST FUND RECOVERY PENAL TY/RELATED PERSONAL CREDIT
MISCELLANEOUS PENAL TY

11.435.00

04-15-2005

82254- 612- 5330 3-6

00000008

RECOVERY PENAL TY/RELATED PERSONAL CREDIT
82254-612- 5330 4-6

MISCELLANEOUS PENALTY IRe 6672 TRUST FUND

18.091.00

04-15-2006

00000008

05-03-2006

CORRECTION OF OFFER IN
COMPROM I SE

02-05-2007
05-03-2006

REVERSAL OF MODULE

BLOCKED FROM FEDERAL PAYMENT LEVY PROGRAM

OFFER IN COMPROMISE PENDING

12-24-2001 Statutory Notice of Balance Due 01-21-2002 Statutory Notice of Intent to Levy 11-03-2003 Statutory Not i ce of Intent to Levy
FORM 4340

(REV.

01-2002)

PAGE

9

f.

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 12 of 13

CERTIF ICATE OF ASSESSMENTS. PAYMENTS. AND OTHER SPECIF lED MATTERS --------------------------------------------------------------------------------

FREDER ICK J KLODT E IN/SSN:
TYPE OF TAX: CIVIL PENALTY

FORM: CVPN TAX PER IOD: DEC 1999
DATE

EXPLANATION OF TRANSACTION

--- --- ----- - - ----- - - - - - - -- - - ---- - - - - - --- -- - - ---- ---- - 05-17-2004 Statutory Notice of Intent to Levy 01-08-2007 Statutory Notice of Intent to Levy

ASSESSMENT. OTHER DEBITS (REVERSAL)

CREDIT (REVERSAL) --- -- - -- - --

PA YMENT.

-

DATE (23C. RAC 006 ) ---- ----- - --

ASSESSMENT.

--

FORM 4340 (REV. 01-2002)

PAGE

10

Case 1:04-cv-00437-WYD-CBS

Document 49-2

Filed 05/09/2007

Page 13 of 13

- - -- - - - -- -- - -- - - - - - - - - - - - - - - - - - -- - - -- - - - - --- - - - - - - -- -- - - -- --- - - - - - - - ------ - - - - --

CERTIF ICA TE OF ASSESSMENTS . PAYMENTS. AND OTHER SPEC IF lED MATTERS

FREDERICK J KLODT E IN/SSN:
FORM:' CVPN TAX PERIOD: DEC 1999 -- - - - - - ---- - --- - - - ---- - - - -- - - ----- --- - - - -- - - - - - -- - - ------ -- -- -- - - -- - - ----- --- - -BALANCE

TYPE OF TAX: CIVIL PENALTY

I CERTIFY THAT THE FOREGOING TRANSCRIPT OF THE TAXPAYER NAMED ABOVE IN RESPECT TO THE TAXES SPECIFIED IS A TRUE AND COMPLETE TRANSCRIPT FOR THE PERIOD STATED. AND ALL ASSESSMENTS. ABATEMENTS. CREDITS. REFUNDS. AND ADVANCE OR UNIDENTIFIED PAYMENTS. AND THE ASSESSED BALANCE RELATING THERETO. AS DISCLOSED BY THE RECORDS OF THIS OFFICE AS OF THE ACCOUNT STATUS DATE ARE SHOWN THEREIN. I FURTHER CERTIFY THAT THE OTHER SPECIFIED MATTERS SET FORTH IN THIS TRANSCRIPT APPEAR IN THE OFFICIAL RECORDS OF THE INTERNAL REVENUE SERVICE.

--------------------------------------------------------------------------------

426,325.62

-- - - - - - ---- - ----------- - ------- ------- -- - - -- -- ----- - - - - - - - - - - - - - - - --- ------ - - --SIGNATURE OF
PRINT NAME:

CERTIFYING OFFICER:~~~ li~
Midge Ward

TITLE:
DELEGATION ORDER:

Supervisor Accounting Technician. Ogden W&I Submission Processing
~w np.Ip.O~tion ()rrlp.r 1 QA

LOCATION: INTERNAL REVENUE SERVICE

ACCOUNT STATUS DATE 02/07/2007

FORM 4340 (REV. 01-2002)

PAGE

11