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I Form 668 (V) (c)
, IAov, Augu,' 19m
Ooportmon! of Ihe Treosury . Inlornol Aevenuo Service
Notice of Federal Tax Lien
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As provIded by sections 6321, 6322, and 6323 of the Internal Revenue
. Code, we are givIng a notice that taxes (IncludIng Interest and penalties)
i have been assessed against the following-named taxpayer, We have made
I a demand for payment of thIs liability, but It 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,
'NameolTaxpayer :",'1, ; .;',
Realdence
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For Opl/onof U.. by R..orrlfng 0",..
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Last Day for Unpaid Balanco 01
RoIIJlng Assossment
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless nolice 01 lien is feWed by Ihe dare given In column (e), this nolice shal',
on 'he day lollowing such date, operate as a certificate of release as de tined in
IRC6325(a).
Kind ofTax Tax Period Ended Identllylng Number Date 01
Assessment
' , (a) (b) (c) (d)
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i Place 01 Filing
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:This notice was prepared and signed at
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.. 'day 01
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i Slgnalure
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Title
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Total
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, on this,
PART 1 ~ KEPT BV RECOnOING OFFICE
(NOTE: Cortificalo of officer .111lhorizod by law 10 1,1ke t1cknowlDdgmonls is not cssonlic1/to IIw validity of Nolico of Federal Tax lien Rev. Rul. 71-488, 1971.2 G.B. 409)
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Form 668 (Y) (c) (RBV.8.97)
CAT. NO 60025X
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