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202502935 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2506000023-4 Pages: 1 <br />Debtor Name: JUAN C VALLEJO DOBLE <br />Filing Date and Time: 06/03/2025 10:51 AM <br />3005 <br />Form 668 (Y)(c) <br />)Rev. February 20041 <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) 829-3903 <br />Serial Number <br />515536025 <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 pena des) <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 tights 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 JUAN C VALLEJO DOBLE <br />Residence 943 S OAK ST <br />GRAND ISLAND, NE 68801-7926 <br />IMPORTANT RELEASE INFORMATION: For each assessment listed below, <br />unless notice of the lien is refiled by the date given in column (o), this notice shall, <br />on the day following such date, operate as a certificate of release as defined <br />in RC 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 D for <br />Raft g <br />(e) <br />Unpaid Balance <br />of Assessment <br />(I) <br />1040 <br />1040 <br />12/31/2021 <br />12/31/2021 <br />XXX-XX-0264 <br />XXX-XX-0264 <br />03/07/2022 <br />07/22/2024 <br />04/06/2032 <br />08/21/2034 <br />272267.99 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 Total <br />Grand Island, NE 68802-1692 <br />$ 272267.99 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 02nd day of May 2025 <br />Signature �i-__f Title <br />( n.- ` Lej TRW SBSE <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 Tax hen <br />Rev. Rul. 71.466, 1971 - 2 C.B. 4091 Form 669(Y)(c) (Rev. 2.20041 <br />Part t - Kept 6y Recording Office CAT, NO 60025X <br />