HomeMy WebLinkAbout97-05094
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Form 668 (V) (e) Depo'lmenl 011111 Treosury . Inlemol Rovenue Servlc.
(Rev, Oclober 1993) Notice of Federal Tax Lien
District 5e,Ial Number Fa' Opuon.1 U.. by R.eo,alnQ Olllel
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AI provld.d bV ..ctlon. 8321, 6322, and 6323 of the Internal Revenue . , ..r.1 ,')
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Cod., W' Irt giving a notlc. thatlaxes (InCluding Interest and penalties) '" 'I) !
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hlv, been aSIlIl.d against the fOllowlng,named taxpayer. We have made " 1I rl
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a d.mand for paym.nt of thl. liability, but It r.malns unpaid, Therofore, -- .',.1
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ther. II a lI.n In favor of the United States on all property and rights to , :1 I
prop.rty b.longlng to thll taxpayer for the amount of these taxes, and '0' ,':1
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addltlona' p.naltlll, Interest, and costs that may accrue, ., ,
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Name of Taxpayer .1
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Residence
IMPORTANT RELEASE INFORMATION: For each assessment listed below, .~quu I'd
unless notice of lien Is retlled by the dale given In column (e), this notice shall,
on the day following such date, operate as a certificate 01 release as defllled (U to! 1,\<.0""
In IRC 6325( al. IZIJ 1',10l.,cl S
Tax Period Date of Last Cay for Unpaid 8a'anc.
Kind of Tax End.d Id.ntlfylng Number Assessment Reflllng of Alleum.nt
(s) (b) (e) (d) (e) (f)
Place of FIling
Total S
1
This notice was prepared and signed at
, on thll,
the
day of
.19_.
Signature
2, (.INL-!..J:R J-J--
Title
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(NOTI: C.rtlflcate of oUletf Ilulhorlzed by 13'101 lo la~i IlcknowledlJmtnts I' not lISuI1'.iaIIO the valiJilt 0' Notle. or Fld"al Tu lI.n
lIev, lIul, 71,oee. 11171 . a cs, 40Q)
Part 1 . K.pt By R.cordlng Ollie.
Form 888 (V)(o) (R.v, 10/~'
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