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Jun. G. 2016 3:35PM NE Secretary of Stag — UCC No. 7216 F. 2%3 <br />Form 668 (Y)(c) <br />(Fiev. February 2004) <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 913 - 6050 <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 ORLANDO ALICEA <br />Residence <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 IRC 6325(a). <br />Kind of Tax <br />(a) <br />1040 <br />1040 <br />Place of Filing <br />Tax Period <br />Ending <br />(b) <br />5216 <br />12/3 <br />12/31/2010 <br />This notice was prepared and signed at <br />the 16th day of June 2016 <br />Signature <br />for PATRICK J KELLOGG <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Serial Number <br />108 W 9TH ST APT D <br />GRAND ISLAND, NE 68801 -3914 <br />Identifying Number <br />(c) <br />XXX -XX -5698 <br />XXX -XX -5698 <br />Date of <br />Assessment <br />(d) <br />04/15/2011 <br />09/16/2013 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />Part i - Kept By Recording Office <br />217445116 <br />Last Day for <br />Refiling <br />(e) <br />05/15/2021 <br />10/16/2023 <br />Title <br />REVENUE OFFICER <br />(308) 663 -6003 <br />201604059 <br />For Optional Use by Recording Office <br />NE See of Stoke lolm A e.l. - Ire Fri. <br />991s77a145 -9 <br />ALICEA ORLANDO <br />Filed: 06/30/2016 01.66 <br />( 0 <br />PM <br />Unpaid Balance <br />of Assessment <br />14705.31 <br />Total $ 14705.31 <br />CHICAGO, IL , on this, <br />24-06-2744 <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) <br />Form 666(Y)(c) (Rev. 2-2004) <br />CAT. NO 60025X <br />