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NE Sec of State - Robert R. Evnen <br />Filing Document #: 1912000570-7 Pages: 1 <br />Debtor Name: 0 VENEGAS RODRIGUEZ <br />Filing Date and Time: 12/12/2019 09:56 AM <br />201907819 <br />Form 668 (Yxc> <br />tRev. Fes,..., 2oo,ti <br />17489 <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 />392607719 <br />For Optional Use by Recording 0 <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 k remains unpaid. Therefore, <br />there is a lien in favor of the United States on alt property and rights to <br />property belonging to this taxpayer for the amount of these taxes, and <br />additional penakks, interest, and costs that may accrue. <br />Name of Taxpayer 0 VENEGAS RODRIGUEZ <br />Residence 1424 E 7TH ST <br />GRAND ISLAND, NE 68801-2922 <br />IMPORTANT RELEASE INFORMATION: For each assessment fisted 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 6325(a). <br />Kind of Tax <br />(a) <br />Tax <br />Ending <br />(b) <br />ideaA <br />identifying Number <br />(c) <br />cess e <br />Assessment <br />(d) <br />Lan Day for <br />Refiling <br />(e) <br />Unpaid Balance <br />of Assessment <br />(1) <br />1040 <br />12/31/2015 <br />XXX -XX -0762 <br />04/17/2017 <br />05/17/2027 <br />2968.39 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Tota) <br />Grand Island, NE 68802-1692 <br />$ 2968.39 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 13th day of November 2019 <br />Signature <br />Title <br />REVENUE OFFICER <br />for DANIELLE L PLATT (402) 473-4675 <br />(NOTE: Certificate of officer authorized by taw to take acknowledgment is not essential to the validity <br />Rev. Rul. 71-466, 1971 - 2 C.B. 4091 <br />Part 1 - Kept By Recording Office <br />26-15-2720 <br />of Notice of Federal Tax lien <br />Form 668(Y)(c) (Rev. 2-2004) <br />CAT. NO 60025X <br />