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NE Sec of State- Robert B. Emco <br />Filing Document #: 2211000050-3 Pages: 1 <br />Debtor Name: GORDON P BLAKE <br />Filing Date and Time: 11/02/2022 08:27 AM <br />202201 181 <br />Form 668 (Y)(c)Notice <br />04) <br />!Rev. February 20041 <br />17628 <br />Department of the Treasury - Internal Revenue Service <br />of Federal Tax Lien <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA 116 <br />Lien Unit Phone: (800) 913-6050 <br />Serial Number <br />461017122 <br />For Optional Use by Recording Office <br />• <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 GORDON P & ROSEMARY BLAKE <br />Residence 2455 LAMAR AVE <br />GRAND ISLAND, NE 68803-6233 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column tel, 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 />1040 <br />1040 <br />12/31/2020 <br />12/31/2020 <br />12/31/2020 <br />XXX -XX -0433 <br />XXX -XX -0433 <br />XXX -XX -0433 <br />04/15/2021' <br />06/07/2021 <br />01/03/2022 <br />05/15/2031 <br />07/07/2031 <br />02/02/2032 <br />29650.69 <br />Place of Filing <br />Register of Deeds <br />Hail POBOX 1692 Total <br />Grand Island, NE 68802-1692 <br />$ 29650.69 <br />This notice was prepared' and signed at CHICAGO, IL on this, <br />the 18th day of October 2022 <br />Signature <br />for COLBY SCHWAN <br />Title <br />REVENUE OFFICER <br />(402) 473-4671 <br />26-14-4822 <br />1NOTE Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien <br />Rev. Rel. 71-455, 1971 - 2 C.B. 4091 <br />Parti •Kept By Recording Office CAT. <br />668(Y)(c) (Rev, 2-20041 <br />CAT. NO 60025X <br />