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{Rev. February 2 ddb {1 004) <br />{pore Fks004) <br />11290 <br />Department of the Treasury - Internal Revenue Service C O <br />Notice of Federal Tax Lien :J <br />Area: <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone: (800) 829 - 7650 <br />Serial Number <br />1453671.15 <br />Far Optional Uae by Recording Office <br />w tin or S k.4- <br />1 <br />•' � <br />II <br />9915750221 -3 <br />Fl 03/06/2015 <br />Aim n e.I. - ak;G <br />1 <br />! ' <br />li <br />� � <br />1 1 <br />Psi: 1 <br />e1 :10 Pm <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Cade, 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 mipaid. Therefore, <br />there s a lien it favor of the linked States on all property and rights to <br />property belonging to this tamperer for free estseast of thew dames, and <br />t, and casts that may accrue. <br />additional penalties, interest, be <br />Name of Taxpayer CHAD CLEMENS <br />• <br />Residence 423 W 5TH ST <br />GRAND ISLAND, NE 68B01 -4507 <br />IMPORTANT RELEASE INFORMATIONS For each assessment listed below, <br />unless notice of the lien is raffled by the date given In column (a), this notice shall, <br />on the day feilewing suet, date, operate as a certificate of roloao) as defined <br />in IRC 6325(a). <br />Kind of Tax <br />(a) <br />Tax Period <br />Ending <br />(b) <br />Identifying Number <br />(c) <br />Date of <br />Assessment , <br />(d) <br />last for <br />R g <br />IF) <br />Unpaid Balance <br />of Agent <br />(0 <br />1040 <br />1040 <br />1040 <br />1040 <br />1040 <br />1040 <br />1040 <br />12/31/2006 <br />12/31/2007 <br />12/31/2008 <br />12/31/2009 <br />12/31/2010 <br />12/31/2011 <br />12/31/2012 <br />X30(. -XX -6520 <br />XXX -XX -6520 <br />XXX - XX - 6520 <br />XXX -XX -6520 <br />XXX -XX -6520 <br />XXX - XX - 6520 <br />XEC -XX -6520 <br />08/08/2011 <br />08/08/2011 <br />08/08/2011 <br />12/02/2013 <br />09/30/2013 <br />09/23/2013 <br />11/18/2013 <br />09/07/2021 <br />09/07/2021 <br />09/07/2021 <br />01/01/2024 <br />10/30/2023 <br />10/23/2023 <br />12/18/2023 <br />2798.72 <br />5152.97 <br />5503.26 <br />2542.67 <br />1475.01 <br />1637..84 <br />3426.63 <br />Place of Filing <br />Register of Deed; <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802 -1692 <br />$ 22537.10 <br />Mar, <br />2015 3:36PM NE Secretary of State - UGC . <br />This notice was prepared and signed at CHICAGO, I I ' , on this, <br />the <br />24th day of February 2015 <br />�s►„ tit' <br />for GRACB SANTACRUZ <br />Signature <br />Title <br />ACS W &I <br />(800) 829 -7650 <br />No. 9557 P, 5 <br />14 -00 -0000 <br />(NOM Certificate of officer authorized by law to take acknowledgment le not essential to the validity of Nodes of Federal Tax ten <br />Rev. Rai. 71 -488, 1971 - 2 C.9. 409) Fares 6680)(c) (Rev. 2 -2 004 <br />Part 1 - Kept By IatCldba OPIt! CAT. N0 60025X <br />