HomeMy WebLinkAbout97-01538
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orm 668 (V) (c)
lRev, October 1993)
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Depa'tment 01 the Treasury, Intern 0' Rovenue Service
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Notice of Federal Tax Lien
8;
Serial Number
For Optional Use by Recording Ollie.
, A, provided by aecllons 6321, 6322, end 6323 of the Internal Revenue
I Code, w. are giving a nollce that taxes (Including Interest and penalties)
I have been assassed against the following. named taxpayer. We have made
I · demand for payment of this liability, but It remains unpaid. Therefore,
I thar. Is a lien In favor of the United Slates on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
I addlllonal penalties, Interest, and costs that may accrue.
,Name of Taxpayer
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of lien Is retiled 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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jPlace of FIling
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IThls nollce was prepared and signed at
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ISlgnature
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Last Day for UnpaId Balanc.
Reflllng of Assessment
(a) (f)
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Date of
Assessment
(a)
Idenllfylng Number
(c)
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Total
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day of
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(NOTE: Cerlllloala 01 officer aulhorlzed by low 10 lake ecknowledgmenls Is nol ellenllallo tho validity 0' Nolloa 01 F.daral Tax lIan
Aay. Aul. 71.4a8, 1971 .2 c,a. 409)
Part 1 . Kept By Recording Otrlce
Form 668 (V) (e) (Rev. 10/0-
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Form 66B(Z)
(Rev.8'97)
Oepartman! ollha Treuury . Internal Aevanua Service
Certificate of Release of Federal Tax Lien
Olllrlc!
Serlll Number
For Ule b Aecordln Olllc.
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(NOTE: C"rtifleal" of officer authorfzed by I.w to take .cknOW//Jd"),,ntl I, not '!lsnt/a' to the validity o( Certiflut. of R"tJU.'ot F<<>>fBI7U IMn RIY. Rut. 7'~ 117'., a.a <<>>)
PART 1 . RECORDING OFFICE
U5,IX)pd
c.v...~ 1~lq'5
R. j/ Un Q 1\
Lal! Day lor Unpaid Balance 01
Aellllng Alaallmenl
(8) (f)
I certify thaI the lollowlng.nlmed taxplyer, under the requlrlment. oll8ctlon 6325 (a)
01 the Internal A.venue Code hu uti. lied the taxII 1I.led below and all .Ialulory
addition.. Therelore, the lien provided by Code lectlon 6321 lor theu taxel and
addition I hu been releuld. The proper olllcer In the olllce where the notice 01
Inlernal revenue lax lien we. flied on .
. II authorized to note the booke 10 ehDw the relaale of Ihle lien for
lh..e laxel and addition..
Name 01 Taxpeyer
Ae.ldenc.
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. :'Klnd of Tax
(a)
Tax Period Ended Identifying Number
(b) (c)
Date of
Aueeament
(d)
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Place 01 Filing
Total $
This notice was preparad and signed al
Ihe
day 01
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Signature
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