HomeMy WebLinkAbout97-00951
Department 01 the lreaeury - Internal Revenue Service
Form 668 (V) (c)
(Rev, October 1993)
'District
Notice of Federal Tax Lien
Serial Number
, AI provided by secllonl 8321, 8322, and 8323 of the Internal Revenue
Code, we are giving a nollce that taxel (Including Interest and penallles)
have been allelled agalnlt the following-named taxpayer. We have made
a demand for payment of thle lIeblllty, but It remains unpaid, Therefore,
there II . lIan In favor of the United States on 0\1 property and rights to
property belonging to thll taxpayar for the amount of these taxes, and
, addlllonal penallles, Interest, and costs that may accrue.
iName of Taxpayer "" "",
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For Oplfonel Uae by Recording 0'iiiCe
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless nollce of lien Is refiled by the date given in column (e), this notice shall,
on the day following such date, operate as a cerlillcate of release as defined
in IRC 6325(a).
Tax Period
Ended
(b)
fl q ,L'v pd
(u..rI J 3'3'W/S'
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Last Day for Unpaid Balance
Reflllng of Allellment
(e) (f)
Kind ofTax
(a)
Idenllfylng Number
(e)
Date of
Assessment
(d)
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Place of Filing
This nollce was prepared and signed at
the day 01
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Signature
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Total $
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Part 1 . Kept By Recording Office
(NOTE: Certlflcata of olllca. aulhorlzad by law to laka aeknowl.dgm.nl' I. nol ....nll.llo Ih. valldlly 01 Nollee 01 Fad.ral Tax lI.n
Rav, Ru!. ",466,1971 ,2 c,e, 409)
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Form 688 (V) (c) (Rev, 10/93)
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