HomeMy WebLinkAbout97-03768
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Form 668 (V) (cl
(Rev, October 1993)
District
Dopa-tmonl of tho Troasury. Intornal Rovonuo Sorvlco
Notice of Federal Tax Lien
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Serial Number
Fa' Optiona' Us. by R.co,dlng Ollie.
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As prOVided by sections 6321, 6322, and 6323 of the Internal Revenue
Code, we ore giving 0 notice that taxes (Including Interest and penalties)
, have been assessed against the lollowlng.named taxpayer. We have mode
a demand lor payment 01 this liability, but 1\ remains unpaid. Therelore,
there Is a lien In lavor 01 the United States on 011 properly and rights to
I property belonging to this taxpayer lor the amount 01 these taxes, and
I additional penalties, Interest, and costs that may accrue.
I Name 01 Taxpayer
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Residence
Ale. q'l-~" ~ 8 (.TL
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IMPORTANT RELEASE INFORMATION: For each assessmenllisted below.
unless notice 01 lien Is refiled by the date given in column (e), this notice shall.
on the day following such date. operate as a certificate 01 release as defined
In IRC 6325(a).
Tax Period
Ended
(b)
Identifying Number
(e)
Date 01
Assessment
(d)
$CjI..:V rei
c.~ul r~n8b'1
\,-j\ 501 n'd
Last Day lor UnpaId Balance
Rellllng of Assessment
(e) (f)
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Kind of Tax
(8)
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! Place 01 Filing
Total S
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This notice was prepared and signed at
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, on this,
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.the
day of
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Signature
, , " ..- 1 /1 . , , ,I] Title
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(NOTE: Certlllcalll of otllcer authorized by law to take ac~,no....led~monIS I, nol e:iser'lliaIIO lhe ,,"lidily 01 Notice 01 Federal Tax II.n
Rlv. Rul. 71-466. IS71 .2 c,e, 4e9)
Part 1 . Kept By Recording Office
Form 668 (V) (c) (Rev. 10/93)
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