HomeMy WebLinkAbout97-05096
Form 666 (V) (c)
(Rev. October 1993)
Dopa-lmo,,1 01 Ihe r,onsu,y . 1"IQII1al Rovo"uo Sorvlce
Notice of Federal Tax Lien
District
Sorlal Numbor
A. provldod by IOcllon. 6321, 6322, and 6323 at tl10 Intornol Rovenue
Cod., we are giving a nolle. that :axes (Including Interesl and penal lies)
have been autssed against th. following-named taxpayer, We hove made
a d.mand for paym.nt of thll liability, but It remains unpaid, Thoretore,
there I. . lI.n In favor of thl United Slattl on 011 property and rights to
prop.rty belonging to this taxpayer for lhe amollnt of these taxos, and
addlllonal penalllts, Intertlt, and costs that may eccrlle,
Name 01 Taxpayer
IMPORTANT RELEASE INfORMATION: for each assessment listed below,
unless notice at lien Is rellled by the date given in column (e), this notice shall,
on the day following such dale, operate as a cer1illcale of release as defined
In IRC 6325(a),
Tax Purl ad
Ended
(b)
Residence
Kind of Tax
(B)
Date of
Assessment
(d)
Identifying Number
(c)
Place of filing
This nollce was prepared and signed at
I
tM
i
day at
,19__,
fl.- ~
Last Day for
Reflllng
(e)
Fo' Oprlon.' U.. by Recording Olli"
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Unpaid Sa'anc.
of Autlsment
(f)
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Total $
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, on lhll,
: Signature [ Tille
(j~It;"{_ f.j:P ~'-
(NOTI: C.rtlflcat. 01 olllelr luthorlZtd by law 10 lake aC~nowlfttlQm.nIS It nor u~.nllaj to lht "lIlldlfy 0' NOlie, 0' 'id.ral r"II,"
Alv. Aul. 71.488, 1871 .2 C.B, 408)
Pert 1 ' Klpl By Recording OUlee
Form sea (V) (e) (A.v, 1 019~'
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