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<br />01/09/2009 FRI 15:20 FAX 402 471 4429 UCC SECRETARY OF STATE ~~~ Hall <br /> <br />121005/005 <br /> <br />.~ <br /> <br />4899 <br /> <br />Form 668 (Y)(c) <br />(Rev. Februarv 20041 <br /> <br />Department of the Treasury - Internal Revenue Service <br />Notice of Federal Tax Lien <br /> <br />Area: Serial Number <br />WAGE & INVESTMENT AREA #2 <br />Lien Unit Phone: (800) 829-7650 505197809 <br /> <br />As provided by section 632 i, 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 Uen 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 /> <br />Name of Taxpayer CARLOS LOPEZ DELGADO <br /> <br />For Optional Use by Recording Office <br /> <br />1"1"11111111" <br /> <br /> <br /> <br />9909582532_5 P . <br />LOPEZ DELGADO CARLOS 9S. 1 <br />. FlIed: 01/09/2009 09:32 AM <br /> <br />200900154 <br /> <br />Residence <br /> <br />1732 S LINCOLN AVE <br />GRAND ISLAND, NB 68801-7146 <br /> <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 following such date. operate as a certificate of release as defined <br />in IRe 6325(a). <br /> <br />Kind of Tax <br />(a) <br />1040 <br />1040 <br /> <br />Tax Period <br />Ending <br />(b) <br />12/31/2003 <br />12/31/2004 <br /> <br />Identifying Number <br />(e) <br />XXX-XX-9306 <br />XXX-XX-9306 <br /> <br />Date of <br />Assessment <br />Cd) <br />12/24/2007 <br />12/24/2007 <br /> <br />Last D~ for <br />Refiling <br />(e) <br />.01/23/2018 <br />01/23/2018 <br /> <br />Unpaid Balance <br />of Assessment <br />(f} <br />3866.41 <br />4163.29 <br /> <br />Place of Filing <br /> <br />Register of Deeds <br />Hall POBOX 1692 <br />Grand Island, NE 68802-1692 <br /> <br />Total $ <br /> <br />8029.70 <br /> <br />This notice was prepared and signed at <br /> <br />CHICAGO, IL <br /> <br />I on this. <br /> <br />o 1st day of January <br /> <br />2009 <br /> <br />the <br /> <br />Signature <br /> <br />Title <br />ACS 12-00-0000 \\\ <br />for DEBRA K. HURST (aOO) 829-7650 <br /> <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. 409) Form 668(Y)(c) (Rev. 2-20041 <br />Part . ~ Kept By Recording OffICe r4T NO Ann?~V <br /> <br /> <br />.J <br />