HomeMy WebLinkAbout97-02475
Form 668 (Y) (c)
:Rev. October 1993)
Ocp.,.tmcnl of tho Troasury . Intornal Rovenuo Sorvlco
Notice of Federal Tax Lien
,DIstrict
Serinl Number
f j I I.
For Opfl'onlll Usa by Rocordfng Off/co
As provided by sections 6321, 6322, ond 6323 of the Internnl Revenue
Code, we are giving a notice that taxes (Including Interest and penalties)
have been assessed against the following-named tnxpayer, We have made
a demand for payment of this liability, but It remains unpaid, Therefore,
there Is a lien In favor of the Unlled States on all property and rights to
property belonging 10 this taxpayer for the amount of these tnxes, ond
additional penalties, Interest, and costs that may accrue,
, Name of Taxpayer ': ,I I " ' ',I
;, I
. I
Kind cof Tax
(a)
Date of
Assessment
(d)
Identifying Number
(c)
j,
Place of Filing
. of I ;" ."
This notice wns prepared and signed nl
the
day of
,19_.
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Last Day for
Reflllng
(0)
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crt- (')L/ 75
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Unpaid Balanca
of Assessment
(f)
'.'-
, on this,
{t~OTE: Cort.I.CJle 0' clker a..J!tlorih':1 t,' :.lo" !.; I.l"t' J_"'~ ....\:~~..d ':~ s r.::\ \!~~.J"'! a; tJ ~~(I "J1,J,l". c.l NOI.e. 01 Federal Tu llen
R,v, Ru!. n..Hie, 1971. '2 C e, 4C9\
IMPORTANT RELEASE INFORMATION: For ea[h assessment I:s1ed belc::,
unless notice of lien is refiled by the dale given in column (e), thiS notice shall,
on the day following such dale, operate as a certificate of re:ease as defined
In IRC 6325(a).
Tax Period
Ended
(b)
Part 1 . Kepi By Recording Office
Total $
Form 668 (Y) (c) (Rev. 10/93)
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