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State of Nebraska 7/2/2019 3:46:17 PM PAGE <br />2/003 Fax Server <br />2 0 1 9 0 3 8 7 0 <br />NESE.col.Sme-RcbmBENTIm <br />Filing Document ?!;i: 1907000115-2 Pages: 1 <br />Dcbtor Name KENNETH PILSL <br />Fling Date and Tne 07/02/2019 10 24 AM <br />1748f:". <br />Form 668 (Y)(0 <br />cidni 2(.03; <br />Department of ;ile T:-eastify - intamal Revenue Service. <br />Notice of Federal Tax Lien <br />Number <br />bUSINESSISELF EMPUn-ED API,A <br />Lien Unit Phone: 4'600) s...13 -6050J <br />3i.34`_,H:48:11 <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we art 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 reniains 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 />Fr C,ptcd-,:cil: Use <br />Marne ot Texpayez A&E PILSL <br />Beici.ence <br />Ill. S AG ETROOD AVE <br />GRAND ISLAND, N0 68007s-4317 <br />IMPORTANT RELEASE INFORMATION: Fnr sh assf;t-r!eryl <br />notice at ;;r$ rati;ed by we ciatc given trt edh.frno ie): this notice tirla;;, <br />01 thE day cIlowr such c.iintc, as a ;:cftific:::tv of :•aicar:n as .cic,iincici <br />in MC 6:3251.6; . <br />Kind of Tax <br />(a) <br />1040 <br />1040 <br />Tax Period <br />Ending <br />(b) <br />12P31/2C17 <br />12/31/201a <br />Identifying Number <br />_____(c) <br />XX -9844 <br />XXX - XX .- 9.1344 <br />Date of <br />Assessment <br />(d) <br />06/04/2018 <br />06/03/2019 <br />Last Day for <br />Refiling <br />(e) <br />0'1/04/2020 <br />07/03/2029 <br />Unpaid Balance <br />of Assessment <br />4011.26 <br />7911.0C) <br />P;ace of Filing <br />RegisteK of Deeds <br />Hall POBOX 1692 <br />Grand Teiland, NE 01' 8 8 0 2 - 1692 <br />'iota! <br />1 1922.26 <br />This notice Was prepaFed end curled <br />;he <br />14th (jay ro June 2019 <br />CHICAGO, IL <br />. on this. <br />Signature „f") Tide <br />ACS 1q&I <br />for (112PiC SANTACRUZ (t300, a29 -7550 <br />ts..- take..:,,:kr;owi,dczm.3n; it not ot,stastio a, le valicia," NOT { ;.,,,d.E,rol 7a): I je,k <br />:•;ev. Cal. -21-zu36. 10.71 - 2 C S. <br />• <br />1.5 -0 0- 0000 <br />Pau i 3,<;epe By Breading Officr <br />Farm 668(7)(41 ii,Ns4. <br />CAT. f0 <br />k3.00a5Y. <br />