HomeMy WebLinkAbout95-01550
,
\ (V) Deportmenl of Ihe Treasury - Inlernel Aevenuo Service
:Form 668 Notice of Federal Tax Lien
IIA.Y, Oelob., 1993)
IOlstrlct Serial Numbe{ For Optiona' Usa by Racording Off/co
I ~ '; i ! j " ; , " . , . /Do 9S'- 16'60
1 As provided by sections 6321, 6322, and 6323 01 the Internal Revanua
I Coda, we ara giving a notice that taxes (Including Interest and panaltlas)
, hava bean assessed against the lollowlng-nsmed taxpayer, We have msde
I a demand lor payment 01 this liability, but It remains unpaid. Tharelore, " ~:
I ,.
1 there la a lien In lavor 01 the United States on all property and rights to ;:r,
I ~
I
, property belonging to this taxpayer lor the amount 01 these taxes, and .,
! addlllonal penalties, Interest, and costs that may accrue.
I w
,Name 01 Taxpayer "
,'1,1 " "
I <:>
I ' , -
, ",'" ...,..,
" " =
'Residence , i,'ii: .: ::~ -
, I u:>
Lrl
I .>iil ' .
, IMPORTANT RELEASE INFORMATION: For each assessment listed below, 'nC( .c:O\X!
I unless notice 01 lien Is reflled by the date given In column (e), this notice shall,
on the day following such date, operate as a cerWlcate 01 release as defined elL it iLl'fl8'
I In IRC 6325(a\, P.dl ri":<.t;'jU
I
, Tax PerIod UnpaId Balance
I Date 01 Last Day lor
I Kind olTax Ended Identllylng Number Assessment Rellllng 01 Assessment
1 (a) (b) (e) (d) (0) (f)
I I(Hi - ' , " I
1
I
1
I
i
!
:
;
,
,
,
I
!
,
i
Place of Filing
, Total $
. i,' I "., "i
jThls notice was prepared and signed at
. on this,
the .'
n ,19_,
//
,
p...
":1'11
Slgnatur
." Tille
mOTE: Corllllcl1lo of ollicer lJulhorllod by law 10 lako acknowIIJd[Jn1Ullls I!J 1101lls6onliallo lho lJahdlly 01 Notice 01 Foderal To_ lion
Rev. Rul. 7\,466, \97\ ,2 c,e, 4091
Port 1 . Kept By Rccordlng Olllce
Form 668 (V) (Rov, 10,93)
~
.
F
'0'
r
I. ,
r
r
f'
n
('\.
r:!
( :
(:
, I
C
'.-
I
.~
C
'..'
~
.- ,
-'
f""\ !
,
i
, I I
,
,..., I
;
I
,
--,
"
r'l
I
I
,-, I
"
i
I
1""1
o
l.[)
l{)
I!
n
!
o
-
I
I.{)
CT
()
'-9
!<.
,
!
C)
,.,'\
'--
, .
I l,...-'
, .',
I \._~
- ,
'.."1
C .
~
l.' I
I
I
L"l !
!
!
,~J !
I
I
I
i
"
I
,
i
I
I
I
~, I