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NE Sec of State - Robert B. Evnen <br />Filing Document #: 1911000133-1 Pages: 1 <br />Debtor Name: JEFF WESTERBY <br />Filing Date and Time: 11/05/2019 11:11 AM <br />20190696 <br />17505 <br />Form 668 (Y)(c) <br />they. February 2004) <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Arent <br />SMALL BUSINESS/SELP EMPLOYED AREA #6 <br />Lien Unit Phone: (800) 913-6050 <br />Serial Number <br />386895219 <br />For Optional Use by Recording Ott ce <br />As provided by section 6321, 6322, and 6323 of the Internal Revenue <br />Code, we are giving a notke 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 JEFF WESTERBY <br />Residence <br />2920 N WEBB RD <br />GRAND ISLAND, NE 68803-1344 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below. <br />unless notice of the lien is refiled by the date given in column (el, this notice shall, <br />on the day following such dme, operate as a certificate of release as defined <br />in IRC 63254). <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 />(b) <br />(c) <br />(d) <br />(e) <br />(I) <br />6672 <br />12/31/2015 <br />XXX -XX -2421 <br />08/08/2019 <br />09/07/2029 <br />3011.76 <br />6672 <br />03/31/2016 <br />XXX -XX -2421 <br />08/08/2019 <br />09/07/2029 <br />3329.38 <br />6672 <br />06/30/2016 <br />XXX -XX -2421 <br />08/08/2019 <br />09/07/2029 <br />4716.62 <br />6672 <br />09/30/2016 <br />XXX -XX -2421 <br />08/08/2019 <br />09/07/2029 <br />4716.62 <br />6672 <br />06/30/2017 <br />XXX -XX -2421 <br />08/08/2019 <br />09/07/2029 <br />3727.94 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 19502.32 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at CHICAGO, IL on this, <br />the 16th day of October 2019 <br />Signature <br />l? i <br />for COLBY SCHWAN <br />Title <br />REVENUE OFFICER <br />(402) 473-4671 <br />26-15-2722 <br />INOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rol. 71.466, 1971 - 2 C.B. 4091 <br />Patti -Kept By Recording office Form 668(Y)(c) (Rev. 2-2004) <br />CAT. NO 60025X <br />