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NE Sec of State - Robert B. Evnen <br />Filing Document #: 2107000084-8 Pages: 1 <br />Debtor Name: LEIGH A WOITASZEWSKI <br />Filing Date and Time: 07/02/2021 10:31 AM <br />20210568 <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 #7 <br />Lien Unit Phone: (800) 913-6050 <br />Serial Number <br />433441421 <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 LEIGH A WOITASZEWSKI <br />Residence <br />2903 HANCOCK PLACE APT 357 <br />GRAND ISLAND, NE 68803 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column lei, 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 />Refiitng <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />6672 <br />12/31/2016 <br />XXX -XX -5001 <br />10/14/2019 <br />55294.48 <br />6672 <br />06/30/2017 <br />XXX -XX -5001 <br />10/14/2019 <br />3641.66 <br />6672 <br />12/31/2017 <br />XXX -XX -5001 <br />10/14/2019 <br />16313.90 <br />6672 <br />03/31/2018 <br />XXX -XX -5001 <br />10/14/2019 <br />13314.42 <br />6672 <br />06/30/2018 <br />XXX -XX -5001 <br />10/14/2019 <br />12606.09 <br />6672 <br />09/30/2018 <br />XXX -XX -5001 <br />10/14/2019 <br />13314.42 <br />6672 <br />12/31/2018 <br />XXX -XX -5001 <br />10/14/2019 <br />8297.20 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 122782.17 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at <br />CHICAGO, IL <br />the 11th day of June 2021 <br />, on this, <br />Signature �/ %� �/ ie <br />C�Ct,✓c.- tstwr- �"`"''"7�J1OIC SPECIALIST <br />for C. MATHERLY (713) 360-8399 <br />27-13-2915 <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. Rut. 71-466, 1971 - 2 C.E. 409) Form 668(Y)(c) (Rev. 2-20041 <br />Part I - Kept By Recording Office CAT. NO 60025X <br />