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L/ <br />Form 666 ( Y )( c ) <br />(Rev. February 2004) <br />11874 . <br />Department of the Treasury - Internal Revenue Service 2 Q ♦ Q C <br />Notice of Federal Tax Lien 1 O d <br />Area: <br />SMALL BUSINESS /SELF EMPLOYED AREA #6 <br />Lien Unit Phone: (900) 913-6050 <br />Serial Number <br />321610918 <br />For Optional Use by Recording Office <br />NE Soo of !k.ka larU A O.ro.- FIL <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 <br />11 <br />111 <br />have been assessed against the following -named taxpayer. We made <br />a demand for payment of this liability, but it remains unpaid. Therefore, <br />1111 <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 />9818819303 - 3 <br />SHANNON <br />Ps:: t <br />additional penalties, interest, and costs that may accrue. <br />mosBy <br />Flied: 09/07/2078 17.54 pM <br />Name of Taxpayer SHANNON CROSBY <br />Residence 3763 W CAPITAL AVE APT N313 <br />GRAND ISLAND, NE 68803 - 1307 <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 />. <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 6325(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 />Refiling <br />of Assessment <br />(a) <br />( <br />(d) <br />(e) <br />(f) <br />6672 <br />12/31 <br />N N h N n N N N N N N r n N N <br />0 0 00 <br />12/14/2015 <br />01/13/2026 <br />1647.74 <br />6672 <br />03/31 <br />12/34/2015 <br />01/13/2026 <br />2101.19" <br />6672 <br />06/3C <br />12/14/2015 <br />01/13/2026 <br />4370.98 <br />6672 <br />09/3€ <br />12/14/2015 <br />01/13/2026 <br />5518.48 <br />6672 <br />12/31 <br />12/14/2015 <br />01/13/2026 <br />6634.48 <br />6672 <br />03/31 <br />12/14/2015. <br />01/13/2026 <br />9685.94 <br />6672 <br />06/30 <br />12/14/2015 <br />01/13/2026 <br />15553.60 <br />6672 <br />09/3€ <br />12/14/2015 <br />01/13/2026 <br />14581.52 <br />6672 <br />12/31 <br />12/14/2015 <br />01/13/2026 <br />15927.93 <br />6672 <br />03/31 <br />12/14/2015 <br />01/13/2026 <br />12889.59 <br />6672 <br />06/30 <br />12/14/2015 <br />01/13/2026 <br />15511.72 <br />6672 <br />09/30 <br />12/14/2015 <br />01/13/2026. <br />13520.14 <br />6672 <br />12/31/2012 <br />12/14/2015 <br />01/13/2026 <br />13340.43 <br />6672 <br />03/31/2013 <br />12/14/2015 <br />01/13/2026 <br />8715.08 <br />6672 <br />06/30/2013 <br />12/14/2015 <br />01/13/2026 <br />11272.44 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 151271.26 <br />Grand Island, NE 68802 -1692 <br />Sep. 7.2018 40PM NE cr eta ry of State <br />This notice was prepared and signed at • <br />the <br />Signature <br />28th day of August 2018 <br />for COLB SCHWAN <br />jube.A_ <br />CHICAGO, IL <br />Title <br />REVENUE OFFICER <br />(402) 473 -4671 <br />No. 0912 F. 4 <br />on this, <br />26 -15 -2722 <br />84 <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 -468, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2 -2004) <br />Part 1 - Kent By Recordline Office <br />