HomeMy WebLinkAbout97-05093
Form 666 (V) (c) Depo't",e"t 01 tho Treosu'y , Into",ol Revenue Servlel
(Rev, October 1993) Notice of Federal Tax Lien
District Serial Number For Optlonll U.. by RICor.fng Ollie.
No en. 5UCf3 FTL
A. plovld.d by ..cUon. 6321, 6322, end 6323 cf the Int.rnel Rev.nu.
Cod., w. ." giving. notlc. thet tax.. (Including Inter..t Ind peneltl..) I') u:' (')
h.v. b..n .......d Igllnst thl followlng.nemed texpeyer, Ws hevs mlde ~ ~ -. '\1
I d.m.nd lor peyment 01 this IIlblllty, but It remelns unpeld, Therefo", rn .
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\her. I. I lien In Ilvor 01 the United Stet.. on ell property Ind rights to I ' ~ ' '0 ,''-\
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prop.rty belonging to thle texpeyer lor the Imcunt 01 th... texes, end ' . -... rrl
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Iddltlonll penIIU... Interest, end co.t. thet may eccrue. .' , -~n
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Nlme 01 Taxpayer " I,",
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Residence " C,'
IMPORTANT RELEASE INFORMATION: For each assessment listed below, ,"1\ q,(;Q !l(~
unless notice of lien Is rellled by the date given In column (e). this notice shall,
on ttle day following such date, operate as a certificate 01 release as defined (,,"Il I '4(.U,-;l?'
In IRC 6325(e). R.lI 'i'uv'i4
Tax Period Olte 01 Last DIY 101 Unplld 81'lne.
Kind 01 Tax Ended Identllylng Number Auessment R.flllng 01 A.....m.nt
(a) (b) (e) (d) (e) (f)
Place 01 Filing
Totel S
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, This notice was prepared and signed at
, on this,
the
day of _
,19__
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Signature./.) I Title
Chf.,:"..L.!"./:J/.w-. L
(NOTI: C,rtlflcatl 01 ol'le.r lulhorlztlJ ~y law 10 take acf.lnowtlogmlnllll!l not essential to thl>> ....alldlty 0' Notice 01 Fede,al lax II."
""v. Aul, 11.455,191\ . a C.B, 409)
PBrt 1 . Kept By Recording Office
Form 666 (V) (0) {Rel/. 10111~'