HomeMy WebLinkAbout94-05009
Notice of Federal Tax Lien
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Form 668 (Y)
(R,y Oelob., Hj!}:)!
DoporllllOll1 01111., TICI"ilJfY - Il1lotlllll f1ovol1uo SOlvlco
'District
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AI provided by sections 6321, 6322, ond 632:l 01 111l' IlIlotllol Revenuo
Code, we ore giving 0 notice that tuxos (Including Inlolo:;1 IInd pennltlos)
hive bien assessed ogolnstthu followlng-nol11ed Inxpoyol, Wo huvo I11nde
I demlnd for poymenl of Ihls liability, but 11 tllll1nlns unpnld. Thereforo,
there II e lien In favor of the Un lied StnloS Oil nil property nl1d rights to
property belonging to Ihls lupoyor for the 011101lnl 01 Ibo60 loxes, ond
Iddlllonll penoltles,lnturust, and cosl.. Ihot mny ucr,lue,
I Name of Taxpayer , . <-
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i Residence
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i Kind 01 Tax
(a)
Identifying Number
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ASS"S5I11ent
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I.ust Doy for
Rellllng
(0)
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(k-lf 75' ',':;J ";>
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Unpaid Balance
of Assessment
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IMPORTANT RELEASE INFOflMATION F,JI' "<lel\ ,\:;""'::;I'\1,,"II11;I,'d blJlow,
unless notice of lien is roldod by Ow oilln QIVI)f1111 (1)11111111 '.1,'), !ill:; nullO) ~~Il;lll,
on the day following such datu, opora!l) ;]~; il cetldl(;l\l: 01 fc'll:n~iO Ii!; rfl:!lr1lJd
In IRC 6325(a .
Tox Period
Ended
(b)
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Total $
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Place of Filing
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This nolice was prepared and signed at
the
! 'day of
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Signature
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"'HIli 668 (Y) Ill,," 10.93)