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NE Sec of State - Robert B. Evnen <br />Filing Document #: 2112000156-6 Pages: 1 <br />Debtor Name: FERNANDO VALENZUELA <br />Filing Date and Time: 12/02/2021 10:56 AM <br />`:`0211024. <br />17489 <br />Form 668 (Y)(c) <br />(Rev. February 2004) <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA #9 <br />Lien Unit Phone: (800) 829-3903 <br />Serial Number <br />439425021 <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 (induding 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 FERNANDO VALENZUELA <br />Residence 1024 W 10TH ST <br />GRAND ISLAND, NE 68801-4006 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below. <br />unless notice of the lien is refiled by the date given in column (e), this notice shall, <br />on the day ollowing such date, operate as a certificate of release as defined <br />in IRC 8325(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 />Refiling <br />of Assessment <br />(a) <br />(b) <br />(c) <br />(d) <br />(e) <br />(f) <br />1040 <br />12/31/2018 <br />XXX -XX -4151 <br />05/27/2019 <br />06/26/2029 <br />37105.00 <br />1040 <br />12/31/2019 <br />XXX -XX -4151 <br />08/17/2020 <br />09/16/2030 <br />1593.24 <br />1040 <br />12/31/2020 <br />XXX -XX -4151 <br />07/05/2021 <br />08/04/2031 <br />3915.68 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ <br />42613.92 <br />Grand Island, NE 68802-1692 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the <br />23rd day of September 2021 <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. Rut, 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-20041 <br />CAT. NO 60025X <br />Part I - Kept By Recording Office <br />