HomeMy WebLinkAbout95-01026
Form 668 (Y) Deperlmenl 01 the Treesury - Internal Revenue Service
(A..", October 1993) Notice of Federal Tax Lien
District Serial Number For Oplional Use by Recording Olllce
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As provided by sections 6321. 6322, and 6323 of tha Internal Revenue :B C15_ )O;;)v ~TL
Coda, we are giving a notice that taxes (Including Interest and panaltles)
hava bean BSsessed against the following-named taxpayer. We have made
a damand for payment of this liability, but It remains unpaid. Therefore,
there Is a lien In favor of the United States on all property and rights to ~"'I ~:~ ....,
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property belonging to this taxpayer for the amount of thesa taxes, and ~: GO
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additional penalties, Interest, and costs that may accrue, 0,"" co
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Name of Taxpayer l'1! I 1\1-'10_; "j- " -Ii "' '" ,i ;' . ,'"
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Residence . I' 1'11. , ',-1 ." ~. -~ ,9'1 ~
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I IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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unless notice of lien Is rellled by the dale given In column (e), this notice shall,
I on the day following such date, operate as a certificate of release as defined LLI t\ ,'ilt&40
In IRC 63251al. /<.1> -;).<l Ul7 5
Tax Period Data of Last Day for Unpaid Balance
Kind of Tax Ended Identifying Numbar Assessment Reflllng of Assessment
(a) (b) (c) (d) (e) (f)
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This notice was prepared and signed at
, on this,
the
day of
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Signature
I Title
(NOTE: CertifIcate 01 allice, authorized bV law to take acknowledgments IS not 855entiallo the validity 01 Notice of Federal Tax lien
Rev, Rul 7',466, '97' ,2 c,e, 4091
Part 1 - Kept By Recording Olfice
Form 668 (Y) (Rev, 10,93)
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