HomeMy WebLinkAbout97-05095
\ Form 666 (V) Ie) Depa.tment ollhe T,.o.ury . Internal Revenue Service
,(Rev, October 1993) Notice of Federal Tax Lien
Olstrlct Serial Number 1'0' Optlcnel V.. by Roco,dlnQ all/co
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AI provld.d by secllons 6321, 6322, and 6323 of the Internal Revenue , - .rl
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Cod., w' Ir. giving I notlc. that taxes (Including Interoot and penalties) , _I "
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hlv, been .......d agalnstth' followlng.named taxpayer, W. hove made ", ;11 I.-TI
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I d.mend for paym.nt of this liability, but It remains unpaid, Therefore, . , ,,14
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ther. Ie I lI.n In fevor of the United States on all property and rights to ' ' (.J "
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property belonging to thle taxpayer f01 the amount of these taxes, end !" I , ..,.)
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Iddltlonal p.nalli.e. Interest, end costs that may accruo, , .,
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Name of Taxpayer ' , ,'I
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Residence
I IMPORTANT RELEASE INFORMATION: For each assessment IIstod below, 'V,'/,C0\xl
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unless notice of lien Is rallied by the date given in column (0), this notice shall.
on the day following such date, operate as a certificate 01 release os delin8d C,"' II I LK'0:J. 3
In IRC 6325(0), '" 1\ ';"',,4....
Tax Period Date of Last Day for Unplld elllnel
, Kind of Tax Ended Identifying Number Assessment ReWlng of Aueument
(a) (b) (e) (d) (e) (I)
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Place of FIling
Totel S
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, on this.
This notlca was prapared and signed at
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day of
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Signature
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Title
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(NOTI: C'rllflcatl Of ofllC.f aulhQrlud by law to ta',cl acknowlidQm.nuls not usantial to lh. lIalldlly 01 NoUc. 01 Fld'fal rlK II.,.
FI.v, Flul, 11,455, li11 ,2 C,8, 409)
Part 1 . Kept By Recording Olflce
Form eee (YI (01 (Rev. 1~'