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!Form 668 (V)
~(R.v. Oclobe, '903)
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Doportmont 01 tho Troasury . Intornal Rovonuo Sorvlco
Notice of Federal Tax Lien
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Serial Number
For Op/lonal Use by Recording Olllce
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As provided by sections 6321, 6322, end 6323 of the Internel Revenue
Code, we ere giving a notlca that taxes (Including Interest and penaltlas)
hava baan assessed agaInst the followlng'named taxpayer. We have made
8 demand lor payment of this lIablllly, but It ramalns unpsld. Therefore,
there Ie 8 lien In lavor 01 the United States on all property and rights to
property belonging to this taxpayer lor the amount of these taxes, end
8ddltlonal penalties, Interest, and costs that may accrue,
IName of Taxpayer
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, 11"1,00['(1
unless notice of lien Is reflled by the date given In column (e), this notice shall,
on the day following such date, operate as a certificate of release as dellned eU,tJ 7QC/I,?
In IRC 6325 a . ,t1 ;),':l,(v';) I I,
Tax Period Date of Last Day lor Unpaid Balance
Kind 01 Tax Ended Idenlllylng Number Assessment Reflllng of Assessment
(a) (b) (c) (d) (a) (f)
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This notice was prepared and signed at
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!~Ignaturel.~v~...v _f'
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(NOTE: CorlUlcnlo 01 olllcu, llulholllOd by low 10 'B~fJ lIck/lowlUllonllJfllf. is nfllIIS5111l11,1110 thu vOllidily 01 NolleD 01 FodlHOI Tnx lion
flov, Aol. 71,466, 1971 '2 C 0, 4091
Part 1 . Kept By Recordlno Office
Form 668 (V) (Rov, 10,93)
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