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20190779 <br />NF Sec of State - Roben B. Evnen <br />Filing Document #: 1912000484-1 Pages: 1 <br />Debtor Name: CAREONE GROUP LLC <br />Filing Date and Time: 12/11/2019 09:20 AM <br />17505 <br />Form 668 (Y)(c) <br />'Rev. February 2004/ <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA #6 <br />Lien Unit Phone: (800) 913-6050 <br />Serial Number <br />395711419 <br />For Optional Use 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 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 CAREONE GROUP LLC <br />Residence 2626 OLD FAIR RD <br />GRAND ISLAND, NE 68803-0000 <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 ollowing such date, operate as a certificate of release as defined <br />in IRC 6325(a). <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 />(f) <br />941 <br />09/30/2018 <br />XX-XXX0924 <br />12/03/2018 <br />01/02/2029 <br />19572.19 <br />941 <br />06/30/2019 <br />XX-XXX0924 <br />09/02/2019 <br />10/02/2029 <br />2619.27 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ <br />22191.46 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at CHICAGO, IL <br />the <br />02nd December 2019 <br />day of <br />on this, <br />Signature <br />avvrr <br />for COLBY SCHWAN <br />Title <br />REVENUE OFFICER <br />(402) 473-4671 <br />26-15-2722 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. RW. 71-466, 1971 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004) <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />