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Dec. 6. 2013 3:46FM NE Secretary of Stat. <br />2oiEto18s� <br />NE SeeatSWs -Jct A, Oafs <br />Piling Document #- 1812000326-7 Pages: 1 <br />Daum Name: JOHN HARRIS <br />Filing Rune cad rime 17/060010 10:41 AM <br />Form 668 (:^004) ) <br />'Rey. <br />11874 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax LienFebruary:DD¢t <br />Area; <br />WAGE & YNVl3SThEN2 AREA #2 <br />Lion Unit Phone: (500) 8.9-7650 <br />Serial Number <br />334308818 <br />For Optional nee by Recording Office <br />As provided by secdon 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 linked States on ail property and rights to <br />property belonging to this taxpayer for rhe amount of these taxes, and <br />additional penalties, Interest, and costs that may accrue. <br />Name of Taxpayer JOHN HARRIS <br />Residence 103 N 23RD ST <br />GRAND ISLAND, NE 68B01-2336 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice 01 the lien is refiled by the date given in column (el, this notice shag, <br />on the day following such date, operate ea a certificate of reieaae es defined <br />in )RC 6325fa), <br />Kind of Tax <br />(a) <br />Tax Petiod <br />Ending <br />(b) <br />identifying Humber <br />(c) <br />Date of <br />Assessment <br />(d) <br />east DAy for <br />RefBeg <br />(e) <br />Unpaid Balance <br />of Assessment <br />i4 <br />1040 <br />1040 <br />12/31/201.4 <br />12/31/2015 <br />XXX -XX -7794 <br />XXX -XX -7794 <br />06/01/2015 <br />06/05/2017 <br />07/01/2025 <br />07/05/2027 <br />4804-06 <br />8388.31 <br />Place of Filing <br />Register of Deeds <br />Ball POBOX 1692 Total <br />Grand Island, NE 66802-1692 <br />$ 13192.37 <br />This notice was prepared end signed at CHICAGO, IL , on this, <br />the 22nd day of November 2018 <br />Signature <br />for GRAC ANTACRUZ <br />Title <br />ACS WPI <br />(800) 829-7650 <br />14-00-0000 <br />(NOTE: Certificate of officer authorized by law to take aoknowledgvnnt is nor essantlal to the validity of Nodce of Felora! Tax lien <br />Rev. Nil. 77•468, 1971 - 2 C.O. 409) Form 668(Y)(e) (Rev, 2-2004) <br />Pan I - Kees By Recording Office CAL NO 60025X <br />