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Form 668 (r)(c) <br />(Rev. February 2004) <br />11874 - <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien 2 018 0 4 8 9 <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829 - 3903 <br />Serial Number <br />315536018 <br />For Optional Use by Recording Office <br />N! <br />9916816706 <br />FLEMING <br />Flied: <br />fec <br />of St•te <br />maRTIN <br />07!3012019 <br />-8 <br />John <br />J he <br />G <br />Gale <br />09:49 <br />- UGC Fi <br />111 <br />Pgs <br />AM <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 MARTIN FLEMING <br />Residence .361.9 CURRAN AVE APT 4 <br />GRAND ISIJAND, NE 68803 - 1242 <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 Last <br />Assessment <br />(d) <br />Day for <br />Refiling <br />(e) <br />Unpaid Balance <br />of Assessment <br />(f) <br />1040 <br />12/31/2016 <br />XXX -XX -4843 <br />• <br />11/20/2017 <br />12/20/2027 <br />• <br />13093.17 <br />• <br />Place of Filing : <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802 -1692 <br />$ 13093.17 <br />Jul. 90.2018 3.13PM NE Secretary of State <br />the 12th day of July 2018 <br />Signature <br />for G.J. TER - LOUIS <br />Title <br />ACS SBSE <br />(800) 829 -3903 <br />No. 0695 P. 2/2 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />24 -00 -0008 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment Is not essentiel to the validity of Notice of Federal Tex lien <br />Rev. Rul. 71 1971 - 2 C.B. 409) Form 66B(Y)(t) (Rev. 2 -2004) <br />Part 1 - Kept By Recording Office l- AT r. in Mn . <br />