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Form 668 (Y)(c) <br />(Rev. February 2OO4) <br />Area: <br />SMALL, BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (Boo) 829 - 3903. <br />Residence <br />Kind of Tax <br />(a) <br />Place of Filing <br />the <br />Aug. 28. 2015 2:59PM NE Secretary of State — UCC No. 2410 P. 2/3 <br />1040 <br />Signature <br />Tax Period <br />Ending <br />(b) <br />5216 <br />12/31/2014 <br />August 2015 <br />13th day of <br />for G.J. CARTER - LOUIS <br />Department: of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Identifying Number <br />(c) <br />XXX -XX -0762 <br />Serial Number <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 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 />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 OCTAVIO VENEGAS & S NIEVES - ATAYDE <br />1424 E 7TH ST <br />GRAND ISLAND, NE 68801 -2922 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is Wiled 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 IRC 6325(a). <br />Date of <br />Assessment <br />(d) <br />06/0 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />171589715 <br />Last Day for <br />Refiling <br />(e) <br />07/08/2025 <br />Title <br />ACS SBSE <br />(800) 829 -3903 <br />201505925 <br />For Optional Use by Recording Office <br />NE See o John A Gale - iCC GTL <br />1111 11 <br />99157600083 Pas. <br />VENEGAS OCTAVIO <br />Flied: 08/26/2015 02:15 PM <br />Unpaid Balance <br />of Assessment <br />(f) <br />8826.54 <br />Total $ 8826.54 <br />This notice was prepared and signed at CHICAGO IL , on this, <br />24-00-0008 <br />(MOTE: 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 />Part I - Kept By Recording Office r itT N!l Fnn9Rx <br />