HomeMy WebLinkAbout97-00963
Dlpartment ollh~ Treasury 0 Internal Revlnue Service
Form 668 (V) (c)
(Rev. October 1993)
District
Notice of Federal Tax Lien
Serial Number
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AI provldad by lectlons 6321, 6322, and 6323 of the Internal Revenue
Coda, we are giving a notice that taxes (Including Interest and penalties)
have been assessed against the followlngonamed taxpayer. We have made
a demand for payment of this liability, but It remains unpaid. Therefore,
thare II a lIan In favor of the Unltad States on all property and rights to
property balonglng to this taxpayer for the amount of these taxes, and
additional panaltles, Interest, and costs that may accrue.
Name of Taxpayer " ,
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Rasldence
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of lien Is reWed by tha 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)
For Optlonel Use by Recording Olllce
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Last Day for Unpaid Balance
Reflllng of Assessment
(e) (f)
Kind of Tax
(a)
Date of
Assessment
(d)
Identifying Number
(c)
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Place of Filing
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This notice was prepared and signed at
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Signature tv.klt,~.. m. ~V-b'!~ I Title
(NOTE: Corlllleal. 01 ollleor authorized by law to lak. aeknowl.dgmenlll. nol ....nUalto Ih. validity or Nollea at Fodoral Tax lion
Rov. Rul. 71.466, 1971 .2 C.B. 409)
Part 1 . Kept By Recording Office Form 668 (V) (c) (Rev. 10/93)
....
Form 668 (Z) I
(Rev, &-V41
Dlltrlcl
Dlpartmenl or Ihe Trealury . Inlernal Revenue Sarvlce
Certificate of Release of Federal Tax Lien
Serial Number
For Uoe by Recording OlflcI
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I certify Ihat el to Ihelollowlng.nam8 laxpeyer, Ihe requlremenl. 01 lecllon 6325 (.)
ollhe Inlem.1 Revenue Code h.va been utl.,led lor Ihe 1...1 lilted below and lor
.11 .tatutory 8ddlllon.. Thlralora, Ihe lien provided by Code section 6321 lor Ihese
I.xe. .nd .ddltlon. h.. been rele.sed. The proper oHlcer In Ihe olllce where the
nollce ollnlemal revenue tax lien w.s lIIed on '
19 '--, I. In aulhorlzed 10 nole Ihe books 10 show Ihe release ollhls lien lor
Ihese taxes and addition.
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Kind 01 Tax
(8)
Tax Period
Ended
(b)
Idenlllylng Number
(e)
Dale 01
Assessmenl
(d)
Lasl Day lor
Rellllng
(e)
Unpaid Balance
at Assessment
(f)
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Place 01 Filing
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This notice was prepared and signed al
. on this,
Ihe '
day 01
,19_,
Signalure
Oa:tt:..LU.:..~
I Tille
(NOTE. C,rMIC.t, 0' offiClr 'Vrhorilld by I.w 10 t,~, .cltnowJedOm8nts IS nol'U'nt,,1 to th. va/kllty 0' C"Mc." 01 R.,.... 01 FId",' T,. h,n R.v. Rul. 7r,468. r97r.2
C,S 409)
PART' . RECORDING OFFICE
Form eea lZl (Rev, 5-;.1)
CAT. NO eoo2el