HomeMy WebLinkAbout97-02479
Form 66B (V) (c)
:Rev. October 19931
Dopn~1rno"t 01 tho Tton!Jury. llllornol novonuo Sorvlco
Notice of Federal Tax Lien
(
District
Sonal ~Jlll1\bor
For Opflonal Use by Rocordlng Ofllell
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As provided by sections 6321, 6322, ~nd 6323 of the Intorn~1 Rovenuo
Code, we are giving a notice that taxes (Including Intorest and ponnltles)
have been assessed against tho followlng.named tnxpnyer, We hnvo m~de
a demand for payment of this lI~blllty, but It remains unpaid. Tharefore,
there Is a lien In favor of the Unltod Statos on all property and rights to
property belonging to this taxpayer for tho ~mount of theso tnxes, and
additional penalties, Interest, and costs that may accruo.
Name of Taxpayer :., " . .
Residence
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IMPORTANT RELEASE INFORMATION: For each a~~e,~rnent Ii~\ed below,
unless notice of lien is reliled by the dilte given In celurnn (el. till, nol,:e Sllilll,
on the day following such date, operate ilS ~ ccrtlllcate 01 rclea,e as del,ned
In IRC 6325(a).
Tax Period
Ended
(b)
Kind of Tax
(a)
Identifying Number
(c)
D~to of
Assessment
(d)
C\.l 11 \:.l./, IILC'(~'
1'- 1~ \) I q(..:S
Lost Day for Unpaid Belance
Reflllng of Assessment
(e) (t)
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Place of Filing
Total $
This nollce w~s prepnred and '''Jnl'd at , on this,
the
day of
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Signature
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(NOTE: Cerl,llcil!e vi (..tl '~Uf Uw!"~:~ 1cJ I., !.I.'o 1) U-t. .1..' ~'.',:c..:~~~e~::>:$ ~.;:I (S5i!~:,a: l~ If'e .a:,j:" cl NC::C9 cf FIICtHal Tax l,en
AI". A\.ll. 71.4GB. 1\01 . ~ C U "'G9)
Part 1 . Kept By Recording Olllce
Form 66B (V) (c) (Rev. 10/93)