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. Department of Ihe Treosury . Inlernol Revenue Service
rOO... (VI
Notice of Federal Tax Lien
(Rlv. October 19(3)
District Serial Number "'ur OpllOnal VtStJ b,v Rl1cordlnQ Olllce
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AI provided by sections 6321, 6322. and 6323 01 the Internal Revenue FTL
Cod., we are giving a notice that taxes (Including Interest ond penoltles)
have been assessed against the lollowing-nemed taxpayer. We hove made r
. d.mlnd lor payment 01 this liability, but It remains unpaid. Therelore, .......,~
th.r. II I lien In lavor of the United States on all property and rights to [. ..,
prop.rty belonging to this texpayer lor tho emount 01 thesa taxes, and 1:.Jt ," .~. -
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addltlonll penalties, Interest, and costs thaI may accrue. -r ':";. .
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. Name 01 Taxpayer ~ 'r. ., a
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IMPORTANT RELEASE INFORMATION: For each assessmonlllshld bolow. -,q.(.;()\'C.\
unless notice of lien Is refiled by the dale given in column (e). this notice s~lall.
on the day following such dale. operale as a cerlificale of reloase as defined (l.4.:t\ ~ .'55 ~4J.
In IRC 6325(0), fl..~ I~III
Tax Period Oate 01 Lest Day lor Unpaid ealanc.
Kind 01 Tax Ended Idenlllylng Number Assessment Rellllng of A.....m.nt
(a) (b) (e) (d) (e) (I)
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Place of Filing
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This notice was prepared and signed 01
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(NOTI: CIHI,h,:;Jtfl ot l)lh,:~( illJlhQriJ.d bl/l.l.W 1<) 1...10.", ,1-"",)/J"!;'i"'-'~;'" - I',' ,;:' '!lll_11 I'l 1/1., v.ll,(Jilf of NL)IICl'l of FaderJI Tall lien
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Signature
Part 1 . Kepi By R(~cC)rcling Orrice
Form 668 (V) (Rev 10.93)