HomeMy WebLinkAbout96-01853
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Form 668 (V)
(A,v. Oelob., 1093)
Deparlment of the Traalury . Inlernel Revenue Service
Notice of Federal Tax Lien
District
Serial Number
For Opl/onnl Us. by noeerdlog O/lle.
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AI provided by eectlone 6321, 6322, and 6323 01 the Internal Revenue
Code, we are giving a notice that taxes (Including Interest and penalties)
have baen assessed against the lollowlng.named taxpayer. Wo have made
a demand lor payment 01 this lIablllly, bul It remains unpaid. Therelore,
there Is a lien In lavor 01 the United Slales on all property and rights to
property belonging to this texpayer lor Ihe amount 01 theso texes, and
addlllonal penalllas, Interest, end cosls thaI may accrue.
~ame of Taxpayer .\11\ iI. I; I'll J I
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IMPORTANT RELEASE INFORMATION: For each assessmentllsled below.
unless notice of lien Is reflled by the dale given In column (e), this notice shall,
on the day following such date, operate as a certificate of release as daflned
In I 26;. ,'" ','. It' 1 (,; ,(\ 11 '\ it i bl, tl .- . I ..., ~ 1\
Tax Period Date 01 Last Day lor
Endad Idenlllylng Number Assessment Rellllng
(b) (e) (d) (a)
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Unpaid Balance
of Assessmant
(I)
C'I
Kind ofTax
(a)
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Place of Filing
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This notice was prepared and signed al _
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( OTI!ICoW; co(u bt O(lLf~d'UlhOrilUd by low 10 toku ncknowludOmunlr. iti nol (lb~ullllnllo tho validl1y 01 Nollea 01 Fodoral To. lion
RoY, nul. 71,466, 1071 '. ,e,4001 66
Pert 1 . KepI By Recording Office Form B (V) (Rov. 10,03)