HomeMy WebLinkAbout97-00950
Form 668 (V) (e)
(Rev, October 1993)
District
Clpartm.nt of Ihe Tr.asury - Interna' R.venue Service
Notice of Federal Tax Lien
Serial Number
For Optional Ule by Recording Oil/c.
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As provided by aectlons 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxas (Including Interest and penallles)
have been assessed against the following-named taxpayer. We hava made
a demand for payment of this liability, but II remains unpaid. Therefore,
there Is a lien In favor of the Unlled States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, Interest, and coats that may accrue.
Name of Taxpayer ,I 1 ..' 'I' I
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Residence
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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)
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Unpaid Balance
of Assessment
(f)
Kind oITax
(a)
Date of
Assessment
(d)
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Last Day for
Reflllng
(a)
Identifying Number
(c)
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Place of Filing
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Total $
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This notice was prepared and signed at
. on this,
the
. day of
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Signature
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Title
(NOTE: Cerllflc.lo of olllcer oUlhorlzod by I.w 10 take acknowl.dgment. I. nol ....nll.llo Ih. Yalldlly of Nollco 01 Fodoral Tax lien
R.Y, Ruf, 71,400, 1971 .2 C,6, 409)
Pari 1 - Kept By Recording Office Form 668 (V) (e) (Rev, 10/93)
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