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Form 668 Y c <br />( )() <br />(Rev. February 2004) <br />3758 <br />Department of the Treasury - Internal Revenue Service 201305116 <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 -6050 <br />Serial Number <br />944740213 <br />For Optional Use by Recording Office <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />NE <br />Sac or <br />54a4a <br />John <br />A Ga <br />- U CC <br />FTI. <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, <br />there is a lien in favor of the United States on all property and rights to <br />belonging to this taxpayer or te amount of these taxes, and <br />property f h f d <br />additional penalties, interest, and costs that may accrue. <br />99137 CLEANING Pgs: 1 <br />VASQUEZ CLEANING SERVICE <br />Filed: 06/26/2013 01:25 PM <br />Name of Taxpayer MAGDALENO VASQUEZ <br />VASQUEZ CLEANING SERVICE <br />Residence 1516 W 3RD ST <br />GRAND ISLAND, NE 68801 -5724 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in !RC 6325(a). <br />Tax Period <br />Date of <br />Last Day for <br />Unpaid Balance <br />Kind of Tax <br />Ending <br />Identifying Number <br />Assessment <br />Refiling <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />940 <br />12/31/2012 <br />26- 0299720 <br />05/13/2013 <br />06/12/2023 <br />80.58 <br />941 <br />12/31/2012 <br />26- 0299720 <br />05/06/2013 <br />06/05/2023 <br />2347.33 <br />Place of Filing • <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 2427.91 <br />Grand Island, NE 68802 -1692 <br />06/26/2013 WED 14:22 FAX 402 471 4429 UCC SECRETARY OF STATE <br />y yti <br />Hall <br />0002/004 <br />This notice was prepared and signet at <br />the 13th day of June 2013 <br />Signature <br />for DANIELLE L MUELLER <br />Title <br />REVENUE OFFICER <br />(402) 473 -4675 x2912 <br />24 -10 -1720 <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 />CAT. NO 60025X <br />Part 1 - Kept By Recording Office <br />1 <br />