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Form 668 (V)
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Depertment althe Treasury. Intarnal Revenue ServIce
Notice of Federal Tax Lien
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Serial Number
For Optional Usa by Raeording Olliea
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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)
hove been asoessed ogalnstthe followlng-nomed toxpayer. We have made
a demand for paymant of this liability, but It remains unpaid. Therefore,
there Is a lion In favor of the United States on all property and rights to
properly belonging to this taxpayer for the amount of these taxes, and
addlllonal penalties, Interest, and costs that may accrue.
,Name of Taxpayor (:";I'J!_IME,;:~ 1 H( " 1. (. ,>,' r \) '..1' I ':. l',
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Kind 01 Tax
(n)
Idontlfylng Number
(e)
Date of
Assessment
(d)
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JJt}ov Jul. ~'rf~99i/
Last Day for Unpaid Balance
Reflllng of Assessment
(e) (f)
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IMPORTANT RELEASE INFORMATION: For each assessment listed below.
unloss notlco 01 lien is reflled by the date given in column (e), this notice shall.
on tho day following such dale, operate as a certilicate of release as defined
In IRC 6325 a ,
Tax Porlod
Endod
(b)
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Placo 01 Filing
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Total $
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This notico was prepared and signed at
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Signaturo
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tNOT[: C,qt,I'C.llu 01 o"lllcor aulh'o-rll~d by law 10 10111.0 .1cknowlj~dgml'nts IS not cssonllallo the validity 01 Nolice of Federal TalC lien
rip.,. 11111 ,'I 4Gfi. 19/1 .2 C B. -409\
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Part 1 . Kept By Recording Office
Form 668 (V) (Rev. 10.93)
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