HomeMy WebLinkAbout97-05092
orm eee (V) (0) OlpD'lmont of lhl TrlOIu,y , Intlrnll Rlvlnue SIIvlcl
~ev, October' 993) Notice of Federal Tax Lien
"slrlcl Serial Number Fo' Optional U.. Oy Rar.O;dlng 0/11,.-
Ii, C)? - 50C; 'J fTL
AI provided by Itcllons 6321, 6322, elld 6323 of the Inlernal Ravenue (1 .',', ,"'J
Cod., we Irt giving a nollce Ihallaxes (Including Interesl and penalties) ~l. -_I 01
have been assassed agalnsllhe following-named taxpayer, We have made (I' I
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a demand for paymenl of Ihls Ilablllly, bul II remains unpaid, Therefore, I" -u
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th.r. II a lien In favor of Ihe Unlled Stales on all property and rig hiS 10 -- ~.'.J
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property belonging to this laxpayer for Ihe amounl of these taxes, and I:.
addlllonal penallles, Inlerest, end costs Ihat may accrue, ."J ,.,1
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Name of Taxpayer ~.) . .rn
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Residence
IMPORTANT RELEASE INFORMATION: For each assessmenlllsled below, $'1 '- ()I~d
unless notice of lien Is reflled by the dale given In column (el. this notice shall, ell +1 HCC,T),
on the day following such date, operate as a certi1icate of release as defined
In IRC 6325(8), f! 1\ S("(~ '-/-,
Tax Period Dale 01 Last Day for Unpaid Balane.
Kind of Tax Ended Identifying Number Assessment Reflllng of Asseument
(a) (b) (e) (d) (e) (f)
Place of FIling
Total S
This nollce was prepared and signed al
, on Ihl"
the
day of
,19_,
Signature (:;> I LTille
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(NOTI: C.rtlfl~'l' of Olllc" lulMor\nd by la'N 10 laic. acknowl.rJgm.n!:t 19 no! .Ulntial to thl validity or Nolle. 0' F.d,ral TI)l, lI.n
".V, lIul, 71.4U, tIlTI .2 C,8, 4011)
Plrt 1 . KepI By Rlcordlng Olllel
Form 8e8 (V) (0) (Rev. 10/9~'
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