HomeMy WebLinkAbout96-06162
668 (V)
OClo IH 199J)
Oeporlmenl of Iho Troosury -Inlornal Revenua Service
Notice of Federal Tax Lien
rict
Serial Numbor
lAs provided by sections 6321, 6322, and 6323 of the Internal Revenue
,code. we are giving a notice thaI taxes (Including Interest and penallles)
have been assessed agalnstlhe following-named taxpayer, We hove made
. demand lor payment of this lIablllly, bul It remains unpaid, Therefore,
' there Is a lien In favor of Ihe Unlled Slales on all property and rlghls 10
: property belongIng to Ihls taxpayer for the amounl of Ihese taxas, and
j addlllonal penalties, Inlerest, and costs that may accrue,
iName of Taxpayer
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jResldence
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IMPORTANT RELEASE INFORMATION: For each assessment Iistod below,
unless notice of lien is refiled by the date given in cclumn (e), this notice shall,
on the day f"liowing such date, operate as a certificate of release as de lined
In IRC 6325 a),
Tax Period
Ended
(b)
Far Optlon.ll Use by Recording OlflC6
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Lasl Day for Unpaid Balanca
Reflling of Asssssment
(e) (f)
Kind 01 Tax
(a)
Dale of
Assessment
(d)
Identifying Number
(e)
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'Place of Filing
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This notice was pro~arod and signod at
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'the day ef _
:Slgn~o J
,19_,
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Total $
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. on this,
Part 1 - Kept By Recording Office
(NOTE: Cnrldlc.lt.. ul 011,(,,1 dulhJfl:l'l.J hy I.lw to (.1;"U ;1(kitl'l',!qf~11l1011!~ I:, n,j! .",';unll.!1 to ltln villtdilV 01 NollClI 01 Fudllri.ll Till! Ilun
nuv. nlll 7l..\hfi. lrj,'l -? en -lD'l1
Form 668 (V) IRev, 10,93)
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