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'Form 668 (V) (c) Dcpil~tmcnt 01 the Treasury . Internal Revenue Service
(Rev, October '993) Notice of Federal Tax Lien
District Serial Number For Optional Use by Rocordlng Office
i' ..ro- c' " , , , i\L ql; SJ~4
As provided by sections 6321, 6322, and 6323 of the Internal Revenue r=TL
Code, we are giving a notice that taxes (Including Interest and penalties)
have been assessed against the following-named taxpayer. We have made
, a demand for payment of this liability, but It remains unpaid. Therefore,
there Is a lien In favor of the United States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, Interest, and costs that may accrue.
Name of Taxpayer 1:),/.;I<h:Y ! " h-l,:', i ,
, '
'Residence 1 ::J:. FAJP'}lE.l>1 UPl [.)(
CA!?L f '3U::., r-' i~, 1 /' ('1 ' ,I' " ,
IMPORTANT RELEASE INFORMATION: For each assessment listed below, -fl <" .e,U (leI
unless notice of lien is refiled by the date given in coiumn (e), this notice shall, Cl< -t! I'J.CII)';r
on the day following such date, operate as a certificate of release as defined
In IRC 6325(a). (<.t1 't~51'i?
Tax Period Date of Last Day for UnpaId Balanca
Kind of Tax Ended Identifying Number Assessment Reflllng of Assessment
(a) (b) (e) (d) (e) (I)
-
J()40 1;~:/;:'),1/':;~' .L ~:: l__' . i::,'.) , , " (.Iii i .;_i':; ':'~;: .I::,l15/').=.:: '::'..'['::1 _ .s.::;
1(:40 1.;'~';:3l/'~'.-;~ l:,:;i~ ......J(f-':~'U':, J J. i., (, ,'~, ;' '_:-I~.:.. _::.' / Cd::. / l~'S
1.04(' 1 '~~~ ./ '31 1;1';; idi':"" \';,'-1<-1(,1_,:':': ;).:1 : '~,:' ,:)-t :,,'::" i '. ~:. / !).~ ~-' l~ i) :~~ . ~~ :;:.~
Place of Filing
F.' ,-.,.... Li-l',' 1"1 ,) ;-,.:..1 '.. Total $
1,.1.1'111 ,~ I . :;:;tl'; ',.i L [', ..~ f." i1 ::. .,:.J::.'
, ;:,,'-'1 ,c IJ-', ('i ~\ I ," )."1
, on this,
This notice was prepared and signed at
the '"I,h day of
'1,,;';:'I"',19~.
SignatlUe (/"
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(NOTE: Co'11I1eale 01 ollleer aulhorlZod'bY law 10 lako aeknowlodgmenls " nol o,,,nlla110 Iho validilY 01 Nol1ce of fedorol Tax lion
Rev. Ru1. 71.466,1971 - 2 C.B. 409)
Pert 1 . Kept By Recording Office
Form 668 (V) (0) (Rev. 10/93'
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