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Form 668 (Y) " Department 01 the Treesury - Internel Revenue Service
(R.v. Oelebs, 1993) Notice of Federal Tax Lien
District Serial Number For Optlondl USB by Recording Ollie6
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As provided by sections 6321, 6322, and 6323 01 the Internal Revenue :llCf5- IOd.;)
Code, we ere giving a notice that taxes (Including Interest and penalties) FTL
have been assessed against the lollowlng-named taxpayer, We have made
a demand lor payment 01 this liability, but It remains unpaid, Therelore,
th.re I. a lien In favor 01 the Unlt.d States on ell property end rights to ... r', ~
prop.rty b.longlng to thl. taxpay.r for the amount 01 thell taxes, and , ' " ...
additional p.naltlll, Int.re.t, and co.t. that may accrue, , '"
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Name 01 Taxpayer '"
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, tIC? cu 1,,1
unless notice 01 lien Is rellled by the date given In column (e). this notice shall, C " tJ ,'8","/(.>
on the day following such date, operate as a certificate of release as defined
In IRC 6325 al. /l.t\ ';). ___lo,l
Tax Period Date 01 Last Day lor Unpaid Balanc.
Kind 01 Tax Endad Identifying Number Assessment Rellllng of A.II..m.nt
(a) (b) (c) (d) (e) (f)
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;Thls notice was prepared and signed at
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, on this,
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day 01
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(NOTE: CetllllclIte of oHlce, authorized by law fo take aCknOw!HdgmcnlS Ie; rot fl!o~f,nlt,lllo Iho valldll,. 01 UOI'ClJ of Fodoral Ta. lion
Rev, Ru!. 71,466, 1971 .2 C,B. 409)
Part 1 - Kept By Recording alllce
Form 668 (Y) (Aov, 10.93)
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