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Form 668 (Y) Doporlmonl allho Troosury , Inlornol Revenue Service
tlRoy, Oclobur 1993) Notice of Federal Tax Lien
i For Optional Usa by Roco'dlng Ol/lco
iDlstrict Serial Number
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I As provided by sections 6321, 6322, and 6323 01 the Internal Revenue PTL
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\ Code, we ere giving e notice that taxes (Including Interest and penalties)
have been assessed against the followlng,named taxpayer. We have made
a demand for payment of this liability, but II remains unpaid. Therefore,
I there Is a lien In favor of the Unlled States on all property and rlghfs to
\ property belonging to this taxpayer for the amount of these taxes, and h '_
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i additional penallles, Interest, and costs that may accrue. -
~ame of Taxpayer ,-.,
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, (..Q
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unless notice 01 lien Is refiled by the date given In column (e), this notice shall, 11 q .L.'<.) fd
on the day following such date, operate as a certificate of release as defined ~tllOil ,
in IRC 6325(al. <:1.<.#73934
Tax Period Date of Last Day for Unpaid Balance
Kind 01 Tax Ended Identifying Number Assessment Reflllng of Assessmen:
(a) (b) (c) (d) (e) (f)
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This notice was prepared and signed at
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Signature
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(NOTE; C..q,l,r ill' 01 ol"(l'r au!tlOflZHd by 1,10\' I;,) l,llo.e iHIoP<.l,"'I,"'dgr!ll!r\l~ 1$ nol essential to tho validity 01 Notice of Federal Tax lien
f1l'V flul II 4HI, 1'):1 ~) C fl 409,
Part 1 ' Kept By Recording Olllce Form 668 (Y) (Rev. 10.93)
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