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Aug, 17. 2010 0:07FM NE Secretary of State <br />Form 668 (Y)(c) <br />(Rev_ February 2004) <br />T <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #6 <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 thls 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 nnay accrue. <br />Name of Taxpayer CHRISTIAN RIVERA GOMEZ <br />Residence <br />Kind of Tax <br />(a) <br />1040 <br />Place of Filing <br />3351 <br />the 20th day of July <br />• <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Serial Number <br />415 W 11TH ST <br />GRAND ISLAND, NE 68801 -3734 <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 />Tax Period <br />Ending <br />(b) <br />12/31/2008 <br />Identifying Number <br />(c) <br />XXX -XX - 4753 <br />Date of <br />Assessment <br />(d) <br />03/14/2011 <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802 -1692 <br />2018 <br />316736116 <br />Last bay for <br />Refiling <br />(e) <br />04/13/2021 <br />Tide <br />REVENUE OFFICER <br />(402) 473 -4671 <br />Nw, u006 F. <br />201805408 <br />For Optional Use by Recording Office <br />ME sec ei 54-1e Jahn P <br />sale FM <br />11111 11111 <br />Pgs: 1 <br />R IIVERA D C HRISTIAN <br />Filed. 08/1712018 10: 44 a[1 <br />Unpaid Balance <br />of Assessment <br />(f) <br />38877.62 <br />Total $ 38877.62 <br />This notice was prepared and signed at CHICAGO, TL , on this, <br />Signature <br />f or COLE / CHWAN <br />(NOTE: Certificate of officer authorized by law to take acknowledgment ie not essential to the validity of Notice of Federal Tax lien <br />Rev. Rul. 71 -466, 1971 - 2 C.B. 4491 Form 668(Y)(c) (Rev. 2 -2004) c.\\ <br />. Yo..e A.. QornrAlns AR1rn <br />26-3_5-2722 <br />