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State of Nebraska 8/29/2019 3:43:22 PM PAGE <br />3/004 Fax Server <br />201905280 <br />NE Sec of State - Robert B Evnen <br />Filing Document #: 1908001554-3 <br />Debtor Name JASON MILLER <br />F i Lng Date and Tune 0S/29/2019 12.56 PM <br />Pages: 1 <br />17.489 <br />Form 6618 (Y)(c) <br />ray.,: -at, c3:, :::X: •, <br />Oi-I3rtrnent o` the TrU.a try - Interni: i3 ver^,t.re Service <br />Notice of Federal Tax Lien <br />Arra: <br />NAt.r. .Y.;i53I.NES'c: 3i? 3.1$ LC 12D APR <br />{.-ion .3r;it Phone: ($OO) 91:1 <br />As provided by section 6321, 6322, and 6323 of the internal Revenue <br />Code, tee are giving a notice that taxes (including interest and Efenaities) <br />have been assessed against the following -manned taxpayer. We have made <br />a demand for paymerit ent off this liability, but it retnaans unpaid. Therefon•e, <br />there is a linen in favor of the United States ran: all property and rights to <br />property belonging to this taxpayer tor the amount of these taxes, and <br />additional penalties, interest, and costs that may accrue. <br />Nime: of Taxpayer JASON MILLER <br />fiesitie: - ce <br />208 E 5TH S'1' APT 6C <br />YORK, N. 68632-00(10 <br />IMPORTANT RELEASE INFQRPfAT1C N: For :each assessment iisted tsetc•w. <br />untue0 not-irr> of t1 ' Iit:n its Wiled by rte!, date given in coitrnen foS tt1t5 rtatk;e Shah, <br />n� <br />trio d1iy taliewing ;,/crr orale. Operate as a 'CM r `tcatcr ur releatie a • t3aiinEa <br />• t ;RC 5�25:ai. <br />C;)iK -1 Use- ray Fiacordi,:o USi-icc <br />Kind of 'fax <br />(a) <br />Tax Period <br />Ending <br />(b) <br />- <br />ldttntifyirxg Number <br />(c) <br />v <br />Date at <br />Assessment <br />(d) <br />v •------ e <br />Last Day for <br />Refiling <br />(e) <br />Unpaid Balance <br />of Assessment <br />(f) <br />941 <br />06/".30/012 <br />X.X--:RXX9:395 <br />07(x10/2017 <br />03/09/2027 <br />4420720.61 <br />Ptect- of Filing <br />Register of Deep <br />Hall LUf3OX 1692 Tot.:i) <br />Grand 1$1ard, NE 68802-1692 <br />$ 4420720.63. <br />This noi•it:t: teas prepared and signed at CI�ZCF�C:O, 3.L s7r t}tis, <br />the <br />:` day of August: <br />201.9 <br />>igrafl_ re J� 7iYir; <br />, REVENUE OFFICER <br />(909) 88-8264 <br />for J. OCHCA <br />27-39-2237 <br />Ceftific.eio of officer ntaf:oriza6Ire !, s- tc tai.: ac%:x:cr;erlgmec:r 0 :lot osso:ttisl to ;lE Not;n:5 c: Fedor_.: 1'nx k;rr. <br />Ray. <br />Flo, 71-466.137i - 2 C.F. <br />Fa.r 1 - Rep( 3)' Recording Office Form 668(Y)(c) (Rev. =.1n }4. <br />._qt. NC; rj T_:Qt;)( <br />