HomeMy WebLinkAbout97-06634
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Fllrm 868 (V) (c) . D.p."lm.nl allh. Treasury. Internal R.v.nu. Servlc.
(Aev. October 1993) Notice of Federal Tax Lien
District Serial Number Fo, Optlon.,VII by RICo,:!lng 011I..
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AI provld.d by ..ctlon. 8321, 8322, and 8323 of the Internal Ravenue qr-l_ lJJ ~ ,':) y. FTL
I Cod., w, Ir. giving. notlc. that taxes (Including Interest and penalties)
have b..n ....SI.d against the following-named taxpayer. We have made
, a d.m.nd for payment of thl. liability, but It remains unpaid, Therefore, (~ , C)
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, th.r. I. a lI.n In f.vor of the Unlt.d States on all property and rights to .. -, !
prop,rty b.longlng to thl. t.xpayer for the amount of th.se taxes, and ., I:J
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, addltlon.1 p.naltl.., Int. rest, .nd eo.t. that may accrue. ,,'"
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!Nam. of Taxpayer r,,', ; j,
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IMPORTANT RELEASE INFORMATION: For each assessment lisled below, ~, /, Cl.)?-J
unless notice 01 lien Is retiled by the date given in column (e), this notice shall,
on the dey lollowlng such dale, operale as a cerlillcate 01 release as delined , '.LolI \4\fl:6
In lAC 8325(a), R II C;; ~'''9,
Tlx Period Date 01 Last Day for UnpaId Sallnea
K1!l4 ofTlx Ended Identifying Number Assessment Rellllng of A.....m.nt
(a) (b) (e) (d) (e) (f)
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This notice was prepared and signed at
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, on this,
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the
ii, day 01
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Signature
(;.cc!J."J;.r... ,
{?!i5.d':U~t';I-';'
Tille
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(NOTI: CellUlell. of olllc'llulhorlud by law to Iik, aClu'lowll.dQm.ntlll nol uuntiallo th. 'oI.lldll)' 01 NoUe. 01 F.d.,al Ta. lI.n
RI', Rul. 71.408, 'a71 .2 C,B. 40ij)
Part 1 . Kapt By Recording Olllee
Form 868 (V) (c) (Rav.10/93) .
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