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Form 668 (Y) , Department 01 the Treuury . Internal Revenue Service
(Rev. October 1993) Notice of Federal Tax Lien
District Serial Number For Optional Us. by R.cordlng Ollie.
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As provided by sections 6321, 6322, and 6323 01 the Intarnal Revenue F1L
Code, we are giving a notice that taxes (Including Interest and penalties)
have been assessed against the lollowlng.named taxpayer. We have made
a demand lor payment of this liability, but It remains unpaid. Therefore, 1.,- n'.
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there Is a lien In favor of the United States on all property and rights to , '"
property belonging to this taxpayer for the amount of these tsxes, end /'"o-l
additional penalties, Interest, and costs that may accrue. .
Name 01 Taxpayer . =
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IMPORTANT RELEASE INFORMATION: For each assessment listed below.
unless notice 01 lien Is rellled by the date given In column (e). this notice shall. ug .(;\.., pc-'
on the day following such date. operate as a certlllcate of release as dellned C,u.U "]Cl'8'"\ ~ RI1 d.:!>5/5
In IRC 6325(al.
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ended Identllylng Number Assessment Reflllng of Assessment
(a) (b) (c) (d) (9) (f)
!,,')4U 1.;~/ :51/'3J 5'1,' 'J::t-g4 ;":~ :",03,"34 11'02/0.1 1425b.OO
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Place of Filing
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ClJHlbf~r I dnd 'l;I)t.,.. 1..t256 . /)(1
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This notice was prepared and signed at
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Signature
Title
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(NOTE: Ccrlilicale ot oHicor authorizod by law 10 taka .:Jcknowludgmenl5 IS not 0550nllallo tho validity 01 Notice of Federal Tu lien
Rov. Ru!' 7',466. '97' .2 C.B, 409)
Part 1 - Kept By Rccordlng Office
Form 668 (Y) (Rev. 10,93)
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Form 668 (Z)
(Rlv. 5.94)
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Deportment 01 tho Treasury. Inlernol Rovonuo Service
Certificate of Release of Federal Tax Lien
District
50rlol Numbor For U.e by Recording Olllce
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I certlly that 00 to the lollowlng.name taxpayer, tho requirements 01 soctlon 6325 (a)
01 the Internal Revenue Code have baen satlstled lor the taxes listed below and lor
all statutory additions. Theralore, the lien provided by Code section 6321 lor these
taxes and additions has been released. Tho proper olllcar In the olllce whore the
notlco ollntemal ravenue tax lien was lIIed on i'l" I I,...
19 ~ Is In authorized to note the books to show the release 01 this lien lor
these taxes and additions
Nome 01 TaxpayerH1:'RbEra ~J .. RUE' 'tfl: hi L';Duf.:,'
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Residence
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COLmr RECORDING INFrmMATION:
L I bel- Pa:~i'! Uc:,-' I~CI"
fIla fila r,(a
Tox Period
Ended
(b)
1lS....,09d
<:..~ caJ35Q RlI d..'<?3'J..
Last Day lor Unpsld Balance
Rellllng 01 Asr.essment
(0) (f)
:::01' J d. r 1"/(1.
Kind 01 Tax
(a)
Idenlllylng Number
(e)
.;'c:.,. 14'.'.,: FI L
Dotool
Assessment
(d)
11)40
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Place 01 FIling
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(umb e I' 1 <lJI d -' ':' l.i :'1 t.:,
Total
$
14251;, . (II)
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This nollcb was prepared and signed at
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. on this.
lh~T j.1 dny.:o.'.........~t'~T~.~.':....192Z-.
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tfIOtf.. Ct"t,..~.;.rtJ lJI Of!,c:.'-' ':1LI1/:ori.'W by loJlV to t.IAe .1,"'n()~ll>dgnl(lm:; jS "0' t1SSlJnt,.ll to t'hl ~'.I:'cuy 0' Ct.,td.l';lle of R~'l'as" of fl>dIJfal rar fjlJn Rs'ol. Rut 7'.466. '91'.2
CO_ 409)
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PART 1 . UEconOIUG efFICE
Form eea (II (Rev. 5-94)
CAT. NO llOO2el
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