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(
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) Form 666 (V) (c)
, (Rov, AUgUBt 1007)
'I
I District
1
I AI provided by sections 6321, 6322, snd 6323 of the Internal Revenue
I Code, we are giving a notice that taxes (Intludlng Interest and penalties)
have bsen sBSessed sgalnstthe followlng.named taxpayer. We have made
I a demand for payment of this liability, but 1\ remains unpaid. Therefore,
I there Is a lien In favor of the United States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
I additional penalties, Interest, and costs that may accrue.
I Name olTexpayer
Deportment 0' tho Troosury . Inlernnl Revenuo Service
Notice of Federal Tax Lien
Serial Number
For Optlonol UIO by Ro.ordlnl1 om..
No.
q~-ID11 FTL
C1 cD 0
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of lien Is reflled by the date given In column (e), this notice shall,
or)'the day following such date, operate as a certificate of release as defined In
IRC,6325(a),
Kind olTax
" (a)
,
Date 01
Assessment
(d)
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Last Day lor Unpaid Balance 01
Rllflllng Assessment
(e) (f)
Tex Period Ended Identifying Number
(b) (e)
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IThls notice was prepared and signed at
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! Signature
Total
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~fi!$)aW to ts..k~.:cknOWledgmonts Is not ossontlal to tho vafidity of Notice of Fodora' Tax lion Rev. Rut. 71-468, r97,.2 C.B. 09(~-~;1.."',
. ~ j PART 1 . KEPT 8'( RECORDING OFFICII! Form 666 (y) (c) (Rev. 8.97) ..., ~,~ .
.J CAT, N060025XW..
(NOTE: Cortiflcat