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Notice of Federal Tax Lion
Islrict
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! AI provided by secllons 6321, 6322, and 63n 01 the Inlernul nevenue
Code, we are giving 0 nollce thai taxes (Including Inll'lesl and penollles)
have been asseBSed against the lollowlng.named taxpayer. We hove mode
I demand lor payment 01 this lIabllllv, but II remains unpaid. 1 herelore,
therl Is a lien In lavor of the Unlled SIele9 on all properly end lights to
property belonging to thl9 fexpayer tor Ihe amount 01 these texes, and
Iddltlonal penalllea, Inleresl, and costs thalmey eccrue,
Name 01 Taxpoyer ,11'11111 ^H\1. 11,/111.'''', I'
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IMPORTANT RELEASE INFORMATION FOI Pillh dSS..",'!1."" k.l"ej Iwlow.
unless nolice 01 lion is reWed by thu datn gIV(~llll1 rolurnn (t') tillS 1l011((~ SllilH,
on tho day following such datu, operalu as i1 cu/IIIlcdln 01 rt;!tlilSH as (j(dlllt.Jd
In IRC 6325 a '
Tex Period
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Kind of Tex
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Identifying Number
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Asse89rnent
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Lest Day lor
Rellllng
(0)
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Place 01 Filing
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This notice was prepared and signed al
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, on thle,
the i ',', t I, day 01 1'1.. y
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Form 660 (Zl
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Dopnllnwnl 01 tho T,o..ury . Inlornol n.v.nuo Borvle.
Certificate of Release of Federal Tax LIen
DI.trlel ,., rorlRi Numbor
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.
I e.rtlly thaI a. 10 tha 'ollowlng.namo laxpoyor, Iho ,oqulr.menla 0' Blcllon 6325 (a)
of Iha Intern.1 R.v.nua Cod. h.v. baan ..lIalled lor Ih. I.... lIal.d b.low .nd lor
.11 'I.tutory .ddlllon., Ther.lor., the lIan provld.d by Cod. lIellon 6321 for thall
I.... and .ddlllona hu ba.n rel.nad, Tha proper olllear In the ollie. whera I~'
nalleo of Internal rovrnUQ tnx lien wos fIIrd on ' '1111 I __
19 '~~'_. Is III oulllorllcd to lIolo tho hooks 10 ~huw Ihe fch!nso 01lhl6 lion for
IhOlo toxoa and oddlllons
Nama 01 T81poye~\I'll ,! r, ',t,l" II ill I'
, 111'\0:11:1 ~HI> '11.\1<111
For U.. by nlcordlng Ollie I
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Unpaid Bolanea
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Kind 01 Tox
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Tax Period
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Idenlllylng Numbor
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Pineo 01 Filing
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11\15 n(Jtlet was pfopClfed and SIgned nt
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Form ..1111 (Rev, &-841
CAT, NO eOO2~1