HomeMy WebLinkAbout96-05280
Form 668 (V) (c) Dcpa~tmcnt 01 the Treasury - Intornal Rovenue Service
(Rev. October 1993) Notice of Federal Tax Lien
District Serial Number ""or Opflonal Usa by Rocofaing Office
I 1~0
. As provided by sections 6321, 6322, and 6323 at the Internal Revenue qUI' .5Jxc FTL
, Code, we are giving a notice that taxes (Including Interest and penalties)
have been assessed against the followlng.named taxpayer. We have made
, a demand for payment of this liability, but It remains unpaid. Therefore,
I there Is a lien In favor at the United States on all property and rights to
I property belonging to this taxpayer for the amount at these taxes, and
additional penalties, Interest, and costs that may accrue,
Name of Taxpayer Ii: II'ii :1' i',.\ ',I' I
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Residence , ,
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, -lloq LLV'
unless notice of lien Is refiled by the date given in column (e), this notice shall,
on the day following such date, operate as a certificate of release as defined (~tI 1;}"'lB~
In IRC 6325(a). (Z Ii >\ ''';:'>1
, Tax Period Date of Last Day for Unpaid Balanc.
Kind of Tax Ended Identifying Number Assessment Reflllng of Assessment
(a) (b) (e) (d) (e) (I)
,~', 1.1 1 " ," ' I ~. ~.:-,: ,__ ~ \.'- ~c' .1 " " . /~':l . ;::: :
Place of Filing
:J, r. f,,1 ',.1 n.' i,':" , Total $
(" UII.L,,: ,I r. tl'J , ;~, 'J ,-, i , . ,~' ", ;'. :~.: ?J
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This notice was prepared and signed at
, on this,
. ,
the --1.2J.ji day of
'':';;'f''_'-'III, ,19_:,;;.;.
Signature
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Title
1-:-,' '-',',:,.' II f I. ('I"
1- ,'; I . I.~ I I I I " '! i , 1.1 ,-1 .. I I'"
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(NOTE: Cortlllcato of ofllcor authorlzod by law 10 lake ackflowledgmonls Is nol ossentlallo tho validity 01 Notice of Fodoral Tax Hen
Aev. Au1. 71-466, 1971 .2 C.B. '09)
Part 1 . Kept By Rccordlng Office
Form 668 (V) (e) (Rev. 10/98'
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