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202306230 <br />NE Sec of State - Robert B. Evnen <br />Filing Document 4: 2311000811-5 Pages: 1 <br />Debtor Name: DOUBLE LINE AUTO REPAIR LLC <br />Filing Date and Time: 11/28/2023 10:42 AM <br />3005 <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 #6 <br />Lien Unit Phone: (800) 913-6050 <br />Serial Number <br />480998923 <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 ail 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 DOUBLE LINE AUTO REPAIR LLC <br />Residence 3700 W 2ND ST <br />GRAND ISLAND, NE 68803-0000 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is ref iled by the date given in column (e), this notice shall, <br />on the day following 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 />CO <br />(f) <br />940 <br />12/31/2021 <br />XX-XXX3851 <br />02/21/2022 <br />03/22/2032 <br />189.67 <br />940 <br />12/31/2022 <br />XX-XXX3851 <br />02/27/2023 <br />03/29/2033 <br />393.49 <br />941 <br />03/31/2022 <br />XX-XXX3851 <br />08/22/2022 <br />09/21/2032 <br />16522.52 <br />941 <br />06/30/2022 <br />XX-XXX3851 <br />08/22/2022 <br />09/21/2032 <br />42118.16 <br />941 <br />09/30/2022 <br />XX-XXX3851 <br />11/21/2022 <br />12/21/2032 <br />27032.85 <br />941 <br />12/31/2022 <br />XX-XXX3851 <br />02/27/2023 <br />03/29/2033 <br />24775.30 <br />941 <br />03/31/2023 <br />XX-XXX3851 <br />05/22/2023 <br />06/21/2033 <br />24829.71 <br />Macao Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />$ 135861.70 <br />Grand Island, NE 68802-1692 <br />CHICAGO, IL <br />This notice was prepared and signed at , on this, <br />the 13th day of October 2023 <br />Signature %� %! _ _ _/ ide <br />a,..^- "� REVENUE OFFICER 26-14-4822 <br />for COLBY SCHWAN (402) 473-4673. <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. Rul. 71-466, 1971 - 2 C.B. 4091 Form 6680r)(c) (Rev. 2-2004) <br />Part 1 - Kept By Recording Office CAT. NO 60025X <br />