HomeMy WebLinkAbout96-05518
Oep:l.tmcnt 01 tho Treasury - Intern:ll Re.....enue ServlCo
Form 668 (Y) (c)
fReu, October 1993}
Notice of Federal Tax Lien
For OplJ:Jnal Uss by Rocoroin;} Of Ilea
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Last Day for UnpaId Balance
Ref1llng of Assessment
(e) (f)
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(NOTE: Cerllllcate of ollicer aulhorlzed by law 10 taka acknowledgments Is not essential to the validity 01 Notice 01 Federal Tax lien
Rev. Rul. 71.466, 1971 .2 C.B. 409)
Serial Number
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As provided by sections 6321, 6322, and 6323 of the Internal Revenue
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 01 Taxpayer
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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
In IRC 6325(a).
Tax Period
Ended
(b)
Hq,LC\"l
KInd olTax
(a)
Identifying Number
(e)
Date of
Assessment
(d)
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IPlace of Filing
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This notice was prepared and signed at
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the'
i day 01
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Part 1 . Kept By Recording Office
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Form 668 (V) (e) (Reu. 1 O/9~'
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FOlm 668 (Z)
(RliI'I.5-;4)
Olll,lcI
Oeplrtment of Ihe Tr"lury . Inlernal RevenuI Sa,vlca
Certificate of Release of Federal Tax Lien
Sarlal Number
For UI. by Recording Ottlce
I certlly thaI aa to Ihelollowlng.nlma taxpayer, lha requlremenls 01 secllon 6325 (a)
01 the Inte,nal Revanua Coda hava DOen salls lied lor the laxes 1I.lad below and lor
all .Iatutory addition.. Therelore, the lien provided by Code .ecllor 6321 lor the.e
laxe. and addition. ha. been released. The proper officer In Ihe olllee where the
nollee 01 Internal revenue lax lien was Wed on,..--.....
19 --' I. In aUlho,lzed 10 nole Iha book. to show Ihe relea.e a' Ihl. lien lor
Ihe.e lexe. and additions
Name 01 Taxpaye,
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Residence
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Kind 01 Tax
la)
Tax Period
Ended
Ib)
Idenlilying Number
Ic)
Date of
Assessment
Id)
Lasl Day for
Reliling
Ie)
Unpaid Balance
of Assessment
(f)
Place of Filing
Tolal
$
This notice was prepared and signed at
, on this,
Ihe
day 01
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Signature
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(NOTE. CerM'eme 0' officer authorized by law fa Mke acknowledgments is nol essontloll /0 Ihe Yillldlly of Certdlcato 01 Release of Federal Tax lien Rell. Ruf. 71.466, 1971.2
C,B.409)
PART 1 . RECORDING OFFICE Form 8158 (Z) (Rev. 5-94)
CAT. NO 600261
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