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NE Sec of State - Robert B. Evnen <br />Filing Document #: 2109000019-2 Pages: 1 <br />Debtor Name: CAROL M CASTLEBERRY <br />Filing Date and Time: 09/01/2021 10:04 AM <br />202107500 <br />Form 668 (Y)(c) <br />(aev. Februmy 2004! <br />17489 <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) 913-6050 <br />Serial Number <br />4:"32539921 <br />For Optional Use by Hecording 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 CAROL M CASTLEBERRY <br />Residence 4147 IOWA AVE <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 re), this notice shall, <br />on the day following such date, operate as a certificate cif 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 />12/31/2019 <br />XXX -XX -9344 <br />08/17/2020 <br />09/16/2030 <br />43625.04 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802-1692 <br />$ 43625.04 <br />This notice was prepared and signed at <br />the <br />28th day of May 2021 <br />CHICAGO, IL <br />, on this, <br />Signature <br />for LISA WILLIAMS <br />Title <br />ACS W&I <br />(800) 829-7650 <br />11-00-0000 <br />(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of federal Tax fieri <br />Rev. ;3o1. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2.20041 <br />Part 1 - Kept By Recording Office <br />CAT. NO 60025X <br />