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Department 01 the Treasury. Intarnal Ravanue Service
'orm 668 (V) (c)
Rev, Oclober 1993)
)Istrlct
Serial Number
Notice of Federal Tax Lien
Far Opl/anal UII by Recording Olllco
':i/('I.5" - J7,1~
FTL
A' provld.d by IIctlons 6321, 6322, and 6323 of the Internal Revenu.
Cod., w. .r. giving a no tic. thet toxes (Including Interesl and penalties)
h.v. been .......d against Ih. following' named taxpayer. We have made
. d.m.nd for paymenl 01 thl, liability, bul It remains unpaid. Therefore,
Ih.re " . lI.n In I.vor 01 th. United States on all property and rig hIs to
prop.rty b.longlng to this taxpayer for the amount of these laxes, and
.ddltlonal p.nalll.., Inter,sl, and cosls that may accrue.
~ame of Taxpayar '.,' Ii
~esldence
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IMPORTANT RELEASE INFORMATION: For each assessmenl listed below,
unless notice of lien Is retlled by the date given in column (e), this nollce shall,
on the day following such date, operate as a certificate of release as defined
In IRC 6325 a .
T.x Period
End.d
(b)
Kind olT.x
(8)
Date of
Assessmenl
(d)
Idenllfylng Number
(c)
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I,
'lace of Filing
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"his nollce was prepared and signed al
he " ~day of " -. ."!"~~'\fY!l ~..:_:,,::; ,
'11'1 , ()Q VI
(\I ~ 'd:J,'>'S'! RU. J-,q;)\
Last Day lor Unp.ld B,'.nc8
Reflllng 01 A.....m.nt
(e) (f)
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Tolal S
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. on this,
lIgna~. 'J:.SJY I Tille
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(HaTE. ClIlIllealo 01 allleor authorized by I.w 10 t.k. .eknowl.dgm.ntl II nol ....nll.1 lu th. valldlly of Nolleo of Fodllal T.. lion
Aoy. Aul. 71.400, 1811 .2 c,a, 408)
Port 1 ' KepI By Recording Olllce
Form 668 (V) (e) (Rev. 10/93)
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