HomeMy WebLinkAbout96-06158
Form 668 (V) (c) Depa.tmonl ollho Troasury - Inlernal Rovonue Service
:Rev. Oclober 1993) Notice of Federal Tax Lien
Olslrlct Serial Number For Opl/ana/ Usa by Rocordlng Omce
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I As provided by secllons 6321, 6322, and 6323 of Iha Inlernal Revenue (11
Code, wa ere giving e notice thai taxes (Including Interest and penalties)
! have been assessed against Iha following-named taxpayer. Wa have made
, a demand for paymenl of this lIablllly, bul II remains unpaid. Therelore, ., ,
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lIhere Is a lien In favor of Ihe Unlled Slates on all property and rig his 10 - ,
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property belonging to this taxpayer for the amount 01 these taxes, and , ' ~ ,",
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additIonal penallles, Inlerest, and costs Ihal may accrue. , "
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Name of Taxpayer ..~
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Residence ,
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IMPORTANT RELEASE INFORMATION: For each assessment listed belllw, 1\q,t.'<.J;1i\'
unless nollce of lien Is rellled by Ihe date given In column (e), this notice shall, ~'l., .t\ \.).-:)~~ll
on Ihe day following such date, operate as a certificate of release as defined
In IRC 6325(a). e..\.\ '-1 '0:) 'i '8
Tax Period Date of Lasl oay for Unpeld Balance
Kind of Tax Ended Idenllfylng Number Assessmenl Rellllng of Assessment
; (a) (b) (e) (d) (e) (f)
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,Place 01 FIling
! TotJI $
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This notice was prepared and signed at
, on this,
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Signature
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(NOTE: Cortlllcatu 01 allleor outhcrlzod by law 10 lako acknowledgments Is nol 8!Isonllallo the 'o'ohdllV 01 Nolle. 01 Fodoral Tax lien
Rlv. Au!. 7104ee, Is?1 .2 C.B. 40a)
Port 1 . Kept By Recording Olllce
Form 668 (V) (c) (Rev. 10/9<1'