HomeMy WebLinkAbout96-05515
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! Dep<t"'tmcnt of tho Treasury. Internal Rovenuo Service
~rm 668 (V) (c)
~ev. October 1993) Notice of Federal Tax Lien
istrict Serial Number For Optional Use by Recording Office
. .. No. ql2- 55\5
I As provided by sections 6321, 6322, and 6323 of the Internal Revenue
, Code, we are giving a notice that taxes (Including Interest and penalties) (:11-
I 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
I property belonging to this taxpayer for the amount of these taxes, and
I additional penalties, Interest, and costs that may accrue.
,Name of Taxpayer ; r ~:!:: i I " " "
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flesldence ,_d,ll -I,
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, 1\n c:cict
unless notice of lien Is refiled by the date given in column (e). this notice shall, \:v.. ~ "!,-;q;').-,O
, on the day following such date, operate as a certificate of release as defined
I In IRe 6325(a). ;'on <-\ on 'O:J.
\ Tax Period Date of Last Day for UnpaId Balance
Kind of Tax Ended Identifying Number Assessment RefJIlng of Assessment
I (a) (b) (e) (d) (e) (f)
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Place of Filing
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This notice was prepared and signed at
I on this,
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(NOTE: CerUllcate of olllesr authorized by law to take acknowledgments Is not essential to the valldity of Notice of Federal Tax lien
Rev. Rul. 71-466,1971 - 2 C.B. 409)
Part 1 . Kept By Recording Office
Form 668 (V) (c) (Rev. 10/98'
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Form 668(Z)
(Rev.a-g7)
Department of the Treasury - Internal Revenue Service
Certificate of Release of Federal Tax Lien
District
Serial Number
For Use by Recording Office
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I certify that the following-named taxpayer, under lhe requirements 01 section 6325 (oj
01 lhe Internal Revenue Code has satisfied the taxes listed below and all statutory
additions. Therefore, the lien provided by Code section 6321 lor these taxes and
additions has been released. The proper officer In the office where the notice 01
Internal revenue tax lien was flied on _~ I
! '," '" Is authorized to note the books to show lhe release 01 this lien lor
lhese taxes and additions.
Name 01 Taxpayer
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I Residence
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Kind olTax
(8)
Tax Period Ended Identllylng Number
(b) (e)
Date 01
Assessment
(d)
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(lHI 1430\2
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Last Day lor Unpaid Balance 01
Rellllng Assessment
(e) (f)
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This notice was prepared and signed at
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, on this,
the
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(NOTE: Cor/lflcate of officar aulhori..od by Imv /0 lake c1cknowlodgmon/s is not eSSlJntiflllo the validity 0/ Certificate of Release of Federal Tax lien Rev. Rut. 71-466, 1971-2 G.B. 409)
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PART 1 . RECORDING OFFICE
Form 669 (Z) (Rov. 8-97)
CAT. NO 600261
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I CORRECTION
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Previous Image
Refilme,d to Correct
Possible Error.