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Form 668 (Y)(c) <br />(Rev. February 2004) <br />3351 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien 2 017 0 51 <br />Area: <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone: (800) 829 -7650 <br />Serial Number <br />271728617 <br />For Optional Use by Recording Office <br />N4 <br />N <br />see <br />-. <br />e! <br />data <br />Jahn <br />A <br />� �, . <br />Oale <br />t <br />- L[� <br />. , <br />, . <br />F7 L <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 />9917795984 <br />HumeuRc <br />EVELYM <br />-6 <br />p <br />AHS <br />1 <br />property belonging to this taxpayer for the amount of these taxes, and <br />Filed 00/52/2017 13:58 AM <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer EVELYN P HUMBURG <br />Residence 948 S LOCUST ST STE 4 <br />GRAND ISLAND, NE 68801-6784 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is raffled by the date given in column le), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 5325(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 />Refilling <br />of Assessment <br />(a) <br />(b) . <br />• (c) <br />(d) <br />(e) <br />(f) <br />1040 <br />12/31/2010 <br />XXX -XX -4813 <br />05/30/2011 <br />06/29/2021 <br />1040 <br />12/31/2010 <br />XXX -XX -4813 <br />02/27/2012 <br />03/29/2022 <br />12611.87 <br />• <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 12611..87 <br />Grand Island, NE 68802 -1692 <br />Aug, 2. 21:117 2:46FM <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 25th day of July 2017 <br />Signature <br />fnr GRACO /SANTACRIIZ <br />Title <br />ACS W &I <br />(800) 829 -7650 <br />No. 4190 F. 2/3 <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. Rut. 71 -466, 1971 - 2 C.B. 409) <br />Part 1 - Kept By Recording Office CAT, NO 60025X <br />Form 668(Y)(c) (Rev. 2 -2004) <br />6 <br />