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NE Scc of State - Robert R. Evncn <br />Filing Document #: 1912000598-3 Pages: 1 <br />Debtor Name: CARLOS GUERRERO <br />Filing Date and Time: 12/12/2019 10:51 AM <br />201907822 <br />Form 668 (Y)(c)Notice <br />(Rev. �ebruarY 24043 <br />04; <br />17505 <br />Department of the Treasury - Internal Revenue Service <br />of Federal Tax Lien <br />Area: <br />Serial Number <br />Fiir Optional Use by Recording Office <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 <br />394313319 <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 retrains 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 woes, and <br />additional penalties, interest, and costs that may accrue. <br />Name of Taxpayer CARLOS & DIANA GUERRERO <br />Residence 1024 N ELM ST <br />GRAND ISLAND, NE 68801-4060 <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 ollowng such date, operate as a certificate of release as defined <br />in IRC 6325(a). <br />• <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 />RefIRng <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e <br />(I) <br />1040 <br />12/31/2012 <br />XXX -XX -5016 <br />01/07/2019 <br />_ <br />02/06/2029 <br />4350.00 <br />1040 <br />12/31/2013 <br />XXX -XX -5016 <br />03/25/2019 <br />04/24/2029 <br />12337.66 <br />1040 <br />12/31/2014 <br />XXX -XX -5016 <br />07/08/2019 <br />08/07/2029 <br />1485.87 <br />1040 <br />12/31/2015 <br />XXX -XX -5016 <br />04/15/2019 <br />05/15/2029 <br />6562.28 <br />1040 <br />12/31/2016 <br />XXX -XX -5016 <br />02/25/2019 <br />03/27/2029 <br />8977.06 <br />1040 <br />12/31/2017 <br />XXX -XX -5016 <br />03/18/2019 <br />04/17/2029 <br />9086.62 <br />1040 <br />12/31/2018 <br />XXX -XX -5016 <br />06/03/2019 <br />07/03/2029 <br />6250.00 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 49049.49 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />the <br />21st day of November 2019 <br />Signature <br />for G.J. CARTER -LOUIS <br />CHICAGO, IL <br />Title <br />ACS SBSE <br />(800) 829-3903 <br />on this, <br />24-00-0008 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validi <br />Rev. Rul. 71-466, 1971 - 2 C.B. 409) <br />Pan 1 - Kept By Recording Office <br />of Notice at Federal Tax lien <br />Form 668(Y)(c) (Rev. 2-2004) <br />CAT. NO 60025X <br />