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Form 668 (Y)
In.,, Oclol,,1I lU9]1
OOl'",lmonl o. Iho T 101Isury . Inlor nul novonllo 50rvlco
Notice of Federal Tax Lien
Dlstrlcl
Surial NUflIlHlf
I j" (111/'PII,1/ US(J b)' HIICofdlnq O"'co
AI provided by sections 6321, 6322, and 6323 of Ihe Internal Revonuo
Cads, we are giving a notlco that laKOS (Including Inlerest and ponaltloa)
hive been assessed agalnsllhe lollowlng.namod ta~payor. Wo havo made
I demand lor payment 01 thla tlablllly, but It remains unpaId. Thoreforo,
there Is a lien In lavor 01 the Unltod Sloles on all proporty and rights to
property belonging to this laKpayer lor tho Ol11ount of tho so taKoa, and
Iddltlonal penalllos, Interost, end coals that may occruo.
Namo of TaKpayor ,
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IMPORTANT RELEASE INFORMATION: For oach a5sossmont listod bolow,
unless notice 01 lion 15 relllod by Iho dato givon In column (0), IIlis notico SllOlI,
on the day lollowlng such dato, operate as a certlficato 01 roloaso as dofmod
In IRC 6325 a .
Tax Period
Ended
(b)
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r \, .\\ ';'I;J~Y 1l\
i'lI JlrU'15
Kind 01 Tax
(a)
Identllylng Numbor
(e)
Dale of
Assessment
(dl
Lost Day lor
Retlllng
(oj
Unpaid Balance
01 Aasessment
(I)
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Total $
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This nollco was preparad and signed at
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"I,ll <,'In!'.11 LJ tILl! Villtd'ly ut NoilCD 01 Fodalal la.llon
rart 1 . KCI'llly ficco/ding Ollfco
Form 668 (Y) (Rov, 10.93)
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