HomeMy WebLinkAbout94-02784
Form 668 (V) Depertment 01 tho Treesury - Internal Revenue Service
'IRev. Ocloblll HltlJl Notice of Federal Tax LIen
District Serial Number I LIt Opflllllill U~f1 by Hf1cordmg Olllce
, Cfy. .)1'84 F
As provided by sections 6321, 6322, and 6323 01 the Internal Revenue
Code, we ore giving 0 notice thot to xes (Including Interest and penoltles) TL
have been ossessod ogalnstthe followlng-nomed toxpeyer, We hove made
a demand for poyment of this lIablllly, but It remolns unpold, Therelore, ,
there Is 0 lien In lovor 01 the Unlled Stoles on 011 proporty and rights fo
property belonging to this taxpayer for the amount 01 these taxes, and r
additional penollles, Interest, and costs that moy eccrue,
Name of Taxpayer r
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Residence -
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, ff '1 eLl I'd
unless notice of lien is refilod by the date givon in column 10), this notice shall, Ck H 73'1.3'1
on the day following such date. operato as a certificate 01 reloase as defined "?tJ 101'20
, In IRe 6325(a).
Tax Period Date of Lost Day for Unpaid Balance
Kind of Tax Ended Identllylng Number Assessment Reflllng 01 Aeeenment
(a) (b) (e) (d) (0) (f)
,
Place 01 Filing
l,;,l, Tolol $
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This notice was proparod and signed at
, on this,
the
day of ,19 _'
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IU01[.1 j II +, ,di' 1;1 r,n"l" .I, \h';'I-;I-,1 1.., "\' ',., I .
Ill'\' ILl ;1 .ll.h llj,'l .' L II .IC')i
I O'IIl 668 (V) (l1llv. 10.931
Signatulu
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Hi' ~oIl,d I,' 01 tj()I" It 01 f 1'l!tHill I ill IIIHl
Pmt 1 . Keptlly Recording Office
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