HomeMy WebLinkAbout97-02934
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Form 666 (V) (c) Depa"menl ollhe Treasury. Inlernal Revenue Service
(Rev. October 1993) Notice of Federal Tax Lien
Dlslrlcl Serial Number Fo, Opl/onal U.a by Raco,dlng OffiCI
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As provided by secllons 6321, 6322, and 6323 of Iha Inlernal Revonue
Code, we are giving a nollce Ihallaxes (Including Inlerosl and penalllos)
have beon assessed against Ihe followlng.namod laxpayor. We hove made " - .
a damand for payment of this liability, but II remolns unpaid. Therefora, '-"
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there Is a lien In favor of the United Stales on all property and rights to ,
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property belonging to this taxpayer for the amount of Ihese laxes, and I : ' -.,
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eddlllonal penallles, Inlerest, and costs that may accrue. I "1
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Name 01 Taxpayer " .0
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IMPORTANT RELEASE INFORMATION: For each assessmenll1sted below, !ll.q.ODpo!
unless notice 01 lien Is reliled by Ihe date given In column (e), this notice shall.
on Ihe day following such date. operate as a certificate 01 release as defined O,Lii \<!.q::lS+
In IRC 6325(0). 1'-1'\" "'~'i?03
TaX Period Date of Last Day for UnpaId Balance
Kind ofTax Ended Identifying Number Assessmenl Reflllng of Assessment
(a) (b) (e) (d) (e) (f)
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Place of Filing
Tolal $
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This notice was prepared and signed al
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the
day 01
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Signature
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(NOTE: C.rllllcat. 01 oUlcer authorized b)' law 10 lake aCknowledgments It not essential to the valldit~ or NoUe. 01 Fld,ral Tax IIln
RI.. Rul. 71'166, 1871 ,2 c.e. 1091
Pert 1 . KepI By Recording Office
Form 668 (V)(c) (Rev. 10/93)
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