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Filing Document #✓1909001195-3 Pages: 1 I <br />Debtor Name: WILLIAM J GALLES <br />Filing Date and Time: 09/25/2019 10:36 AM <br />201905892 <br />form 668 (Y)(c)Notice <br />(Rev. February 2004) <br />17489 <br />Department of the Treasury - Internal Revenue Service <br />of Federal Tax Lien <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 <br />Serial Number <br />380508719 <br />For Optional Use by Recording Office <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 this 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 may accrue. <br />Name of Taxpayer WILLIAM J GALLES <br />Residence 306 S SHADY BEND RD <br />GRAND ISLAND, NE 68801-8470 <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 8325(a). <br />Kind of Tax <br />(a) <br />Tax Period <br />Ending <br />(b) <br />Identifying Number <br />(c) <br />Date of <br />Assessment <br />(d) <br />Last kay for <br />Refg <br />(e) <br />Unpaid Balance <br />of Assessment <br />(f) <br />1040 <br />1040 <br />12/31/2016 <br />12/31/2017 <br />XXX -XX -3304 <br />XXX -XX -3304 <br />06/10/2019 <br />06/24/2019 <br />07/10/2029 <br />07/24/2029 <br />28078.76 <br />29114.17 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802-1692 <br />$ 57192.93 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 09th day of September 2019 <br />Signature <br />C.r e2„.11.1( - <br />for G.T. CARTER -LOUIS <br />(NOTE: Cortlficate of officer authorized by law to take acknowledgment is not aseentia <br />Rev, Rut, 71-466, 1971 - 2 C.B. 409) <br />Title <br />ACS SBSE <br />(800) 829-3903 <br />o the validity of Notice of Federal Tax lien <br />Form 668(T)(c) (Rev. 2-2004) <br />CAT. NO 60025X <br />Part t - Kept By Recording Office <br />24-00-0008 <br />