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Form 668 (V)
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DopUII1l10111 01 Iho Tron.uIV . InlOll1ol Ruvonuu !iulvleo
Notice of Federal Tax Lien
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AI provided by secllons 6321, 6322, ond 6323 01 tile Il1lulIlnl IkVOI1LJO
Code, we are giving a nolleo Ihal tOKOS (lncludll1g Inlolo'll und p0/101tIe5)
have been a55essed agol/1sllhe following-named tOKpuyor, Wo huvo mode
a dllmand lor paymonl of Ihls liability, but It rCll1ul/1s lJlll1uld, Thernloro,
there II a lien In favor of Ihe Unltod Slotes 0/1 ull propolty und I'lghlS 10
I property belonging 10 Ihls laKpayer lor tho amOlJllt 01 111'150 luxus, and
additional penallles, Inleresl, ond cosls Ihot Il1UY aCCIue,
,Name of Taxpayer ,'ie.,.1 .:,!
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IMPORTANT RELEASE INFORMATION: For '),1cI1 ,1S"'-''.:;lIIo;lIt l,st,,,II),21ow,
unless notice of lien is relilod by tho dalll glV01l11I COIIJIlIIl ("I. 111IS llotiCll ,;1",11,
on the day lollewing such dahl, opmlllo as II cmtlllcatc 01 ,c(casu .IS dclil1ed
in IRC 6325(a ,
Tax Period
Endod
(b)
Unpaid Balance
of AS18ssment
(I)
Kind of Tax
(a)
Idenllfylng Number
(e)
Dule of
Ass"ssrnent
(dl
Last Day lor
Reflllng
(e)
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Place of Filing
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Tolal $
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This notice was prepared and signed at
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, on this,
the
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(NOTE: C'HI,li':ilt,. t!' <)1',(0[ ,1l.,)-.),I:,ld IIY 1.1," I.j t"",. ''-''':11",1 It ", I I,!,II I,) IIII! 'J,J:I!llly 01 N,)t'(Q,;,f Feder...1 Tax 11l3n
f1~v flul 11 .:H:, ,,),', ;! C '-' ,1':'), '
Signatu re
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11,11
PM! 1 . KI.!pt Dy Fk,'()rdln'l Office
Form 668 (V) (Rev, 10-93)
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