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a <br />NE Sec of State - Robert B. Evnen <br />Filing Document #R 2003001460-6 Pages: 1 r <br />Debtor Name: PEDRO RUIZ <br />Filing Date and Time: 03/25/2020 09:45 AM <br />202001872 <br />17489 <br />Form 668 (Y)(c) <br />!Rev. February 20041 <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA #4 <br />Lien Unit Phone: (800) 829-3903 <br />Serial Number <br />413981820 <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 PEDRO RUIZ & NAIVI VELAZCO <br />Residence 1420 W ANNA ST <br />GRAND ISLAND, NE 68801-6609 <br />IMPORTANT RELEASE INFORMATION. For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (e1, 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 Period <br />Ending <br />(b) <br />Identifying Number <br />(c) <br />Date of <br />Assessment <br />(d) <br />Last Day for <br />Refiling <br />(e) <br />Unpaid Balance <br />of Assessment <br />(f) <br />1040 <br />12/31/2018 <br />XXX -XX -3865 <br />06/03/2019 <br />07/03/2029 <br />12000.00 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802-1692 <br />$ <br />12000.00 <br />This notice was prepared and signed at CHICAGO, IL on this, <br />the 17th day of March 2020 <br />Signature <br />for G.J. CARTER -LOUIS <br />Title <br />ACS SBSE <br />(800) 829-3903 <br />24-00-0008 <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- Rul. 71-466, 1971 - 2 C.B. 4091 Form 668(Y)(c) (Rev. 2-20041 <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />