HomeMy WebLinkAbout97-01213
DIPlrtm.nt 01 thl Trl"ury . Inl.rnll R.vlnul Slrvlel
Form 666 (V) (c)
(Rev. October 1993)
District
Notice of Federal Tax Lien
Serial Number
,-j I'
AI provided by IIctlons 6321, 6322, and 6323 of the Interne I Revenue
Code, we ere giving a notice Ihallaxes (Including Interest and penalties)
have been assessed agalnslthe following. named laxpayer. We have made
a demand for payment of Ihll lIa"lIIty, but II remain I unpaid. Therefore,
there II a lien In favor of Ihe Unlled SIatDl on all properly and rig hIs 10
property belonging 10 Ihll laxpayer for Ihe amounl of these laxes, and
additional penaltlel, Inlerell, and cOllllhal may accrue.
,Name of Taxpayer
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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 I'erlod
Ended
(b)
For Opl/on.1 U.. by Rtcordlng Olllel
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Lasl Day for Unpaid Balance
Reflllng of Aseeaamenl
(e) (f)
Kind ofTax
(a)
Date of
Aasessmenl
(d)
Identifying Number
(c)
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:Place of FIling
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,This notice was prepared and signed at
Ihe
. , l day of
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Tota' $
, on this,
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(NOTE: Cffllllell. 01 ollleff lulhorlzod by 'ow 10 lok. oeknowl.dgm.nl, I. nol ....nll'IIO thl vllldlty 01 Nollel 01 Fld..11 Tullln
R.v, Rul. 71.~e8. 1971 .2 C.B. ~09)
ParI 1 . Kept By Recording Office
Form 668 (V) (c) (Rev. 10/93)
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