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Oepertment 01 the Treuury - Interne' Revenue Service
'orm sea (V) (e) Notice of Federal Tax Lien
(Rev, Oclober 1993)
Olstllct Sellal Number Fo, Ool/on.1 u.. by R,co'dlng Ollie.
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M provIded by ..cllons 8321, 8322, and 8323 of the Internal Revenu.
Cod., w. .r. Illvlnll . nollc. th.t taxes (Including Interut and penalUes)
have be.n .......d .g,'nlllh. following-named taxpayer. We have made
. d.m.nd for p.ym.nt of thIs liability, but It r.malns unpaid. Therefore,
ther. II I lI.n In favor of th. Unlt.d Statu on all properly and rights to ..
property b,'onglnll to thll t.xpay.r for Ih. amounl of Ihu. taxes, and ,
.ddltlon.' p.nalll.., Inter..I, .nd costs thai may accrue. ,
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Nam. ot Taxpayer ,
'./ ll"lut .. ':Mr, .. VA'-,', [-:' fl! ,
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R..ldence ';:,11.1-';' :;r:'f--. [t'H~"'H)1 j:::~F (,j"lilL! !." .
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IMPORTANT RELEASE INFORMATION: For each assessment hsted below, ~q UO p.'
unless notice of lien Is lellled by the dale given in column (e). this nolice shall. \:.1.....1 1;;[ '; >!' H
~nl:~ ::~ fOIl~wl~,9 ,s~c~_,~at~. ,o?~~at~'~sr~ ce~i,lIcata of re,l~ase:: ,defined \l...Il ~<...:> :~ '/ (..
Tax Period Date of Last Day for Unpaid Balancl
KInd of Tax Ended Identltylng Number Assessment Reflllng of Assessm.nt
(a) (b) (e) (d) (e) (f)
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This nollce was prepared and signed al
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(HOT I: C.rtlllca" of ollie., authorized by law to fakl acknowledgmenls Is nol u'Jenllal to lh. validity of Notice at Fed.'11 Tax lI.n
Rov, Rul. 71.~se. 11171 . a C.B. 409)
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Part 1 . Kept By Recording Olllce
Form 888 (V) (c) (Rev. 10/93)
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