HomeMy WebLinkAbout97-02931
IForm 666 (V) (c)
, (Rev. October 1993)
I
, District
Depa:1menl 01 the Treasury - Internal Revenue Service
Notice of Federal Tax lien
Serial Number
For Opl/onal U.. by Rocordlng 0/11"
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N<:o. q1-~q31 FTL
I As provided by sections 6321, 6322, and 6323 of the Internal Revenue
I Code, we ora giving a notice that taxes (Including Interest and penalties)
, have been assessed against the fOllowing-named taxpayer. We have made
I a damand for payment of this liability. but It remains unpeld. Therafore,
I there Is a lien In favor of the United States on all property and rights to
! property belonging to this taxpayer for the amount of these taxes, and
additional penaltlas, Interest, and costs that may accrue.
l Name of Taxpayer "I
I
, Residence
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless nollce 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 Period
Ended
(b)
Identifying Number
(c)
Date of
Assessment
(d)
Uq,Q0 pd
c...ui- 139015<{,
f{ tl 5~li'oo
Last Day for UnpaId Balancl
Reflllng of Assessment
(e) (f)
Kind of Tax
(a)
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: Place of Filing
Total $
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This notice was prepared and signed at
_ . on this.
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the
day of
.19_.
Signature
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(NOTE: Certificate 01 ollleer authorized bV law to lake acknowledgments II not usenllal to the validity or Nollel ot Flde'al Tax lI.n
Rlv. Rut. 71,466, 197\ ,2 c.a. 409)
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Part 1 - Kept By Recording Olllce
Form 666 (V) (e) (Rev. 10/93) ""