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202504135 <br />NE Sec of State - Robert B. Evnen <br />Filing Document #: 2507001086-9 <br />Debtor Name: SHANNON BURKS <br />Filing Date and Time: 07/29/2025 10:20 AM <br />Pages: 1 <br />'1.)) Form 668 (Y)(c) <br />(Rev. February 20041 <br />3005 <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) 913-6050 <br />Serial Number <br />519283025 <br />For Optional Use by Recording Office <br />As provided by secdon 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 SHANNON BURKS <br />Residence <br />539 LITTLE BLUESTEM DR 5 <br />GRAND ISLAND, NE 68803-3070 <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 83251a). <br />Kind of Tax <br />(a) <br />1040 <br />Tax Period <br />Ending <br />(b) <br />12/31/2023 <br />Identifying Number <br />(c) <br />XXX-XX-4476 <br />Date of <br />Assessment <br />(d) <br />09/30/2024 <br />Last Re ayfiling <br />(e) <br />10/30/2034 <br />Unpaid Balance <br />of Assessment <br />(f ) <br />98837.88 <br />Place of Filing <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br />Total $ 98837.88 <br />This notice was prepared and signed at CHICAGO, IL , on this, <br />the 02nd day of July 2025 <br />Signature r__ %1 s <br />f+rCr^- ACS SBSE 24-00-0008 <br />for D.J. RAMSEY (800) 829-3903 <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. Rul. 71-466, 1971 - 2 C.B. 409) Form 668(Y)(c) (Rev. 2-2004) <br />Part I - Kept By Recording Office CAT. NO 60025X <br />