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Area: <br />WAGE & INVESTMED7T AREA #2 <br />Lien Unit Phone: (900) 629 - 7650 <br />Serial Number <br />241644516 <br />For Optional Use by Recording Office <br />. <br />NE S4G eq <br />9918784386 <br />CHRPR <br />FilSd : 1h 1 <br />Filed <br />!Rai <br />2 <br />2/25/2 <br />-4 <br />/201fi <br />„ N <br />1242 <br />G.lw <br />_ UGC GiL <br />P9f; 1 <br />PM <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 MARIANNA CHAPA <br />Residence 817 9TH ST <br />GRAND ISLAND, NE 68801 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is relied 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 />Tax Period <br />Ending <br />(b) <br />Identifying Number <br />(c) <br />Date of <br />Assessment <br />(d) <br />Last Day for <br />Refilling <br />(e) <br />Unpaid Balance <br />• of Assessment <br />(f) <br />1040 <br />1040 <br />12/31/2002 <br />12/31/2003 <br />XXX -XX -8107 <br />, XXX -XX -8107 <br />03/30/2009 <br />03/30/2009 <br />04/29/2019 <br />04/29/2019 <br />16300.30 <br />12899.85 <br />• <br />• <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 ' Total <br />Grand Island, NE 68802 -1692 <br />$ 29200:15 <br />,Dec. 23. 2016 2:24PM NE Secretary of State — UCC <br />Form 668 (Y)(c) <br />(Rey. February 2004) <br />the <br />11874 <br />13th day of December 2016 <br />Signature <br />f or GRACE SANTACRUZ <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Title <br />ACS WSJ <br />(B00) 829 -7650 <br />No. 9194 <br />201608 9.5 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />14 -00 -0000 <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 />Part 1 - Kept By Recording Office Form 66B(lf) I. - 20 X <br />CAT. . N NO vO 6000267( <br />