HomeMy WebLinkAbout94-05027
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'Form 668 (V)
(Rev. O,lobtlr ""'13)
Oopnrlrnont I)f tllo 1II'lI',\IIY. InllHIl1l1ltnvlHlll0 5orvlco
Notice of Federal Tax lien
District
-i-;;;(:),J/ll1l1,I/IJ.~1J by FI"cording OUlce
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AI provided by secllons 6321, 6322, ond 632:J of Iho InltwlUl Rovcnuc
Code, we lire giving 0 notlco thot tOKes (lncll/dlng 11110"",1 nnd penalties)
hlvl been assessed agalnsllhe followlng-numod 11Ixpuyor, We hnvo made
. demand for payment of this liability, bul II romulne l/npold, Therefore,
there II a lien In fovor 01 the United Stotes on all prorelly and rights to
property belonging to this IOKpayer tor Ihe omollnt ot these loxes, and
Iddlllonal panaltles,lnlerest, and costs thotll1l1Y nCCIlW,
Name at Taxpayer,,, ".1 I I I I ;.,.1, i , ,
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IMPORTANT RELEASE INFORMATION. For o:lell ;I~:;W;':IlII!1I1 1i:;lild balow,
unless notice of lien is rolilod by tho datn G,vell ill colUIlHl In), 1111:' 1l01leo ~ll;)II.
on the day following SUCll data, operntu ;IS n cOllillC:ltO 01 11)1"'1::" ;I,; delinod
In IRC 6325 a' ,
Tax Pari ad
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Identifying Numbor
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Duto of
Asscs!illH:mt
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Lasl Day ror
Rollllng
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Unpllld Balance
of Asseslment
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Kind of Tax
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,Place of Filing
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This notice was prepared and signed at
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the
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Signature , , ",I :1, II" _________I~dll1
INOTE: C'.tl.I" ,Ht' I'll I)!"<:H ,ll;;!h;d~"'d by I.].', 1'1 \ II." , ".":'1
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I'olrn 668 (V) (flev. 10-93)
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