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NE Sec of State - Robert B. Evnen <br />Filing Document #: 2301000821-5 Pages: 1 <br />Debtor Name: OCTAVIO VENEGAS <br />Filing Date and Time: 01/18/2023 08:54 AM <br />202300273 <br />17628 <br />Form 668 (Y)(c) <br />(Rev, Febrtary 2004i <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br />Area: <br />SMALL BUSINESS/SELF EMPLOYED AREA ti4 <br />Lien Unit Phone: (800) 829-3903 <br />Serial Number <br />464662622 <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 OCTAVIO VENEGAS <br />Residence <br />1424 E 7TH ST <br />GRAND ISLAND, NE 68801-2922 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (el, this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in IRC 63251a1. <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 />Refilling <br />(e) <br />Unpaid Balance <br />of Assessment <br />(f) <br />1040 <br />1040 <br />12/31/2018 <br />12/31/2020 <br />XXX -XX -0762 <br />XXX -XX -0762 <br />03/02/2020 <br />10/04/2021 <br />04/01/2030 <br />11/03/2031 <br />3267.67 <br />3030.91 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total $ <br />6298.58 <br />This notice was prepared and signed at <br />the ...__..... <br />21st December 2022 <br />day of . <br />CHICAGO, <br />, on this, <br />Signature (Ll� i Ce <br />ACS <br />.4t ACSBSE <br />for D.J. RAMSEY (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 Tex lien <br />Rev, Rol. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) [Rev. 2.2004) <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />