HomeMy WebLinkAbout96-06165
orm 66B (V) lc)
rev, Oclober 1993)
Istrlct
Depo,tment olthe Treasury. Internal Rovenue Service
Notice of Federal Tax Lien
For Optlon.t usa by R.cordlng Oll/ce
Serial Number
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As provided by secllons 6321, 6322, end 6323 01 the Internal Ilevenue
Code, we are giving a nollce that taxes llncludlng Interest and penalties)
have been assessod against the following. named taxpayer, We have made
. demand for payment of this liability, but It remains unpaid, Therelore,
there Is a lien In favor of the United States on all property and rights to
property belonging to this taxpayer lor the amount 01 these taxes, and
addlllonal penallles, Interest. and costs that may accrue,
ame 01 Taxpayar
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IMPORTANT RELEASE INFORMATION: For each assessment listed beloW.
unless notice of lien Is reflled by the dale given In column (e), this notice shall,
on the day lollowlng such date, operate as a certificate 01 release as defined
In IRC 6325(a),
Tax Period
Ended
(b)
Identllylng Number
(e)
Date 01
Assessment
(d)
Last Day for
Rellllng
(e)
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UnpaId Balanc.
01 Assessment
(I)
Kind ofTax
(a)
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'Place 01 FIling
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Total $
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,This notice was prepared and signed at
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the
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Signature /)
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Title
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(NO :'Conlllea'o 01 011I,", au'horlZod by I.w to t.ko .cknowl.dgmanlS " not ..,onll,I'o tho valldlll 01 NolICl 01 Fodoral To. lion
Rov, Rul, 7\.406, \971 .2 c,a, 409)
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Part1 . Kept By Recording Olllce
Form 66B (V) (c) (Rev, 10/9:'>'