HomeMy WebLinkAbout97-06893
Form 666(Z)
(ROY.e,g7)
Cepertment 01 the Troeeury' Internel Revenue Service
Certificate of Release of Federal Tax Lien
Olelrlol
Serlel Number
For Uee b Reoordln Ollloe
I oertlfy thet Ihe loll owing-named texpeyer, under the requlremenle 01 "eotlon 6325 (e)
01 the Inlernll Revenue Cod. he. .ltI.lIed the texee listed below Ind III .t.tutory
Iddltlonl. Th.rolore, tho lion provided by Codo BOctlon 6321 for th... tIXO. end
Iddltlon. hll been r.les.ed. Tho proper olllc.r In Iho offlco whero Ih. notlc. 01
Intorn.1 revenue tax lien wae mod on \:>.\-1.5\'1'1 ,
, II .uthorlzod 10 not. the book. to .how tho rol...e 01 thl. lion for
tho.o tax.. ond addition..
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Kind ofTlx
(e)
Tex Porlod Ended Identifying Number
(b) (c)
Oelo 01
Allo..menl
(d)
Laet Day lor
Rollllng
(e)
Unpaid Balance of
A.e.llmant
(I)
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i>iiiCeOi Filing
Totll
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This notice WRS prepared and signed at ---
, on this,
..'
the
,day of
1--'
Signature /) LT11Ie - __
( J: I,;,! / J' ~ "
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(NOTe: C'r'm~Br. of offle" lIutfwl"d by I~w trJ fdk. Ilcknnwlluf\1moflt.lltJ nor e~4dn/ltll to t/llt vitI/ally of C.rtlflcaf. of R61"4~1J af Ftdtlr.1 T4;( lI.n R". Rut. 11-466, ''''-2 C.s. 40eJ
PART 1 ' R!COROINQ OPPICI
Form'" (Z) (ROY, 11-11)
CAr. "OftCXlQtj
iForm 668 (V) (e)
:(Rev, October 1993)
District
Depo'tment 01 the Treosury - Internol Revenue Service
Notice of Federal Tax Lien
Serial Number
Fa, Optional U" by R.co,dlnQ Olllce
,.
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ft"
((7 -lr~r~ \-'lL
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A. provided by aeellons 6321. 6322, and 6323 01 the Internal Revenue
Code, we are giving a nollee that taxes (Including Inleresl and peneltles)
have been assessed against the followlng.named taxpayer. We have made
. demand for payment 01 thll liability, but It remains unpaid. Therefore,
therl II 8 lien In favor 01 the United States on all property and rights to
property belonging to Ihls taxpayer lor the amount 01 these taxes, and
additional penaltlel, Interesl, and costs that may accrue,
Name of Taxpayer
,',
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Residence
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IMPORTANT RELEASE INFORMATION: For each assessment lisled below,
unless notice of lien Is reflled by the dale given In column (e), this notice shall,
on the day lollowlng such date, operate as a certificate of release as dellned
In IRe 6325 e),
Tax Period
Ended
(b)
Identllylng Number
(c)
Date of
Assessment
(d)
tll?L\..l\X''fc;cr
l'..ut 1'\\f.'1'-1
Kit f qqll
Lllst Day for Unpaid Balancl
Rellllng 01 Asseumanl
(e) (~
...
Kind of Tax
(a)
"',.\ '
, Place 01 FIling
,
Total $
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I This notice was prepared and signed at , on this,
I
day of
.19_.
, Signature
,
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(NOTI: C.rUflr.llt ot officer luthorlud by law 10 lal<e uIJknowltdQmtnU l't not IU1lJtlllallo Ihe v&II"lly 01 NOlie. 01 F.lJe,al Tax lI.n
,..., R.I, 1\,488, 1971 ,2 e,a, 409)
Peril. Kept By Recording Olllco
Form 666 (V) (0) (Rev, 1 O/9~'
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