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Oepertment 01 the Treasury - Internal Revenue Service
Certificate of Release of Federal Tax Lien
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Form 668 (Z)
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For u.. by Rleordlng Olllee
Serial Nllmbar
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I Clrtlfy that aa tD tha IDIIDwlng-nama taxpayar, the requirements DI aaetlDn 6325 (a)
Dlthe Intarnal Revenue Code hava baan aatlalled IDr tha taxes IIstad belDw and fDr
allll.tutDry .ddltlDna. TherefDra, the lien prDvlded by CDde aeetlDn 6321 IDr thase
tlXe. and addltlDns haa baan relaaaed. The prDper Dllleer In the offlea whare the
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nDtle~ .~f Internal ravenuetax lien was fIIad Dn . "
19 --' Is In authDrlzad tD nDta the bDDka tD ShDW tha release Df this lien fDr
rheaa taxes and addltlDna
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This nollc6 wus prepared and signed at
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~NOTE: CtUMC.lllI Of olllc,,' ilutho,ized by 1.1W 10 tallu aclln~menlS IS net l'ssontJ<JI to ,he val.ddy cI COfIilJCiHt! of RefeasfI 01 Fede,al Tax ben R.v Rut 11.466 1971.2
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PART' . RECORDIIIG OFFICE Fo,mOOa(ZJIRov.5-94)"
CAT. NO 800281
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Form 668 (Y) .:.[" Departmenl ollhe Treasury. Inlarnal Revenue Service
(Rev. Oclober 1993) Notice of Federal Tax Lien
District Serial Number For Optiona' Use by Recording Olllce
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As provided by sections 6321, 6322, and 6323 of the Internal Revenue FTL
Code, we are giving a notice that taxes (Including Interest and penalties)
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but It remains unpaid. Therefore,
there Is a lien In favor of the United States on all property and rights to
property belonging to this taxpayar for the amount of these taxes, and
additional penalties, Interest, and costs that may accrue. =-
Name of Taxpayer ;~;; 'U
LiLLIE li'lC . c. '-- _',' ," ~, '.1 j . , ""
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Residence '. '
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, ,-. '" .:;X
unless notice of lien is reliled by the date given in column (e), this notice shall, -- '!2. k 1J: 1/11 'I
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on the day fO~\~Wing such date, operate as a certillcate of release as defined t/lq .00 bl c '..,j:!
in IRC 6325(a . R;;,.j~ i9qJ
Tax Period Date of Last Day for Unpaid Balan.,.
Kind of Tax Ended Identifying Number Assessment Reflllng of Assessment
, (a) (b) (e) (d) (e) (f)
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This notice was prepared and signed at h '" ," , ;.j" " f.' I,
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(NOTE: Certlficale 01 ollicor au'-hoflzed by law 10 laku aclo.nowlodgments is not ossenthlllo the valldily 01 Notice at Federal Ta. lion
Rov Rul 71,466, 1971 .2 CB, 409)
Part 1 . Kept By Recording Office
Form 668 (Y) (Rev, 10.93)
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