HomeMy WebLinkAbout96-06156
Depa,tmenl 01 the TreBlury . Internel Revenue Service
Notice of Federal Tax Lien
Form 668 (V) (c)
(Rev. October 1993)
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Serial Number
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! AI provided by lectlons 6321, 6322, and 6323 of the Internal Revenue
I Code, we are glvlnll a notice that laxes (Including Inlerest end penalties)
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, hava been assessed against Ihe followlng.named laxpayer. We hove mode
I a demand for payment of this liability, but It remains unpaid, Therefore,
1 there II a lien In favor of the Unltad Slales on all properly and rlghlS 10
, property belonging to this taxpayer for Ihe amounl of Ihese laxes, and
: additional penallles, Inlerest, and cosls Iha\ may accrue.
IName of Taxpayer " I'
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jReSldence
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice 01 lien Is rellled by Ihe date given In column (e), this notice shall,
on Ihe day fOllowing such date. operale as a certificate of release as defined
In IRC 8325(a).
Tax Parlod
Ended
(b)
For Opl/anal U.. by Recording Olflce
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Kind oITalC
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Idantlfylng Number
(e)
Oale of
Assessment
(d)
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Last Oay for
Rellllng
(e)
Unpaid Balanca
uf Assessment
(f)
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f)
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(NOTE: Certlfleat. 01 olllcer authorized bv raW 10 take acknowledgmenls Is not essential to the validity 01 Nolle. 01 Federal TI)( lien
R.v. Rul. 71..ee, 1e71 . a C.B. .09)
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iPlace of FIling
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iThls nollce was prepared and signed at
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'Ihe day of ' '
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Part 1 . Kepi By Recording Olllce
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Tolal $
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Form 668 (Yl(cl (Rev. 1 O/9~'