HomeMy WebLinkAbout97-04678
Form 668 (V) (c)
[ROV,Octol)'" 1 'Y1:i)
Ol1pU-tflllJllI 011110 Tr"IPjllJ Y . InttHfHll HUVUf111U Sutvlce
Notice of Federal Tax Lien
--E---'--- _________.__________u.__.._
District GUII..I IJlJlIIllel
-------.- - -_.----.~----
A. provided by aectlons 6321, 6322, ond 6323 of 1110 Int~rnal Revenuo
Code, we ore giving 0 notlco that toxes (Incllldlng Int~rost and pelHlltlos)
hsv. been assossad against tho followlng.named tax payor. Wu have 1110d,'
I demond for poyment of this liability, but It rel11alns unpaid. 'T11ereforo,
there Is a lien In fovor of the United States on 011 proporly ond rights to
property belonging to this taxpayer for tho omollnt of IIle~o toxes, ond
additional penalties, Interest, and costs that may accrlle.
Name of Taxpayer
Residence
IMPORTANT RELEASE INFORMATION: For each assessment listn.d below,
unless notice of lien Is reliled by tho date given in colJmn (el, this nolice shall,
on the dey following such date, operate as a certificate 01 releoso as deflnod
In IRe 632~(al.
Tax Period
Ended
(b)
- Fer OIJIIt./IoiUilby /lICordlng 011I"
~L. q'7-4wl~ F1L
".
'-' "
i') ,,'
J
, ,
,
, ,'j
, ,
III
I
I "
II:) ",
il q .00 t'C
(~..!\ ','{fill: ,)
"',t) 5'j,&0.,"1
Last Day for Unpaid Bllanct
Reflllng of Assesament
(e) (I)
Kind of Tax
(a)
Identifying NlIrnber
(e)
Date of
Assessment
Id)
I
Place of FIling
'This nollce was prepared and signed at
the
day of
,19_.
Total $
':' '. I'
~~g~n~~~;,e,. ,_...... (?";:,..' J/' .1:.. .. __J:
(NOTE: Cerllflcate 01 olllc.r aulhorluu by la'N 10 laklt a~knowlt,!dllmijn\s I:J not o!i!iol'llllJI 10 tho valiully 01 Nollee Of Ftlderat T8)( II."
Rov. Rul. 71"68,1971.2 C,B, '09)
Port 1 . Kept By Recording Ofllce Form 668 (V) (0) (Rev. 10/93)
, on this,
0(
"',
~ .
," I
....
""
.
.
.
..
-
~ .
tl,f11
.. ,~
...
..'
~ ,
'-'