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,Fo~m 668 (V)
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Depertment 01 tho Trouury -Internel Revenue Service
Notice of Federal Tax Lien
District
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A. provided by eectlon. 6321, 6322, and 6323 01 the Internal Rovenue
Code, we ere giving e nollce that taxes (Including Interest and penallles)
have been a88used against the lollowlng.named taxpayer. We hava mode
a demand lor payment 01 this lIablllly, but II remains unpaid, Theralore,
there Is a lien In lavor 01 the Unlled States on 011 property and rights 10
I' property belonging to this taxpayer lor the emount 01 these taxas, and
i addlllonal penalllss, Inlerest, and costs thet may eccrue,
I Name 01 Taxpayer ,I", I' ,', 1/\ 111, I" I 1 1
{iResldenco J" J I:J 1/'1< ,t\L, II" I,P
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IMPORTANT RELEASE INFORMATION: For each assessmenlllstod below,
unless notice of lien Is reflled by Ihe dale given In column (0), Ihls notice shall,
on the day following such dale, operate os a certlllcate 01 ralease es defined
In lAC, 6325 ...., t.. II..'" I ' ,',' I"" I
For Opl/ona' U.. by R.cordlng Oll/ce
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KInd 01 TalC
(a)
TalC Period
Ended
(b)
Identifying Number
(c)
Dale 01
Assessment
(d)
R.I
Lest Day lor
Rellllng
(8)
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Unpaid Balance
01 Auesament
(f)
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/ Place of Filing
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This notice was prepared and signed at
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Totel
$
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, on this,
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( Tir;. (ab,. 61 oU,cu, nUII";";IId by 'iI'... 10 liI'" iI"n"""""UIlI"nh, Iii nol '''''unl",llu 11111 'illld,'y 01 Nolieu 01 Fedu,n' To, liun
R.v, Rul, 71,400, 107/ '2'C,O, 400)
Tltlo
Part 1 . Kept Dy Rccordlno Ol"co
Form 668 (V) (Rov. 10,93)
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