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Form 66S(Z) Deportment of the Treaaury . Internal Revenua Service
(Rev 8.97) Certificate of Release of Federal Tax Lien
District Serlel Number For Use by Recordlno Olllca
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I certify that the followlng.named taxpayer, under the requirements of section 6325 (e)
of the Internal Ravenue Code haa aatlsfled the taxes listed below end all atatutory
addltlona, Tharefore, the lien provIded by Code aectlon 6321 for theae taxea and
additions haa baen released, The propar olllcer In the olllce where the notice of
Intarnal revenue tax lIan waa flied on .
__,_-'-~, Is authorized to nole the books to show the release of this lien for <" .0 C'>
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thase taxes end addltlona, <;:, -... ..,
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Kind of Tax Tax Period Ended Idenlifylng Number Date of Last Day for Unpaid Balance of
(a) (b) (e) Assassmant Raflllng Assassment
(d) (a) (f)
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Place of Filing
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This notice was prepared and signed at
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the
- , day of
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Signature
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(UQTf. Cl'rr I"IIt> 0' OlflCll' dllltwfUtJlI by IiiI\' '0 Idle aclo.ncMlcdpmonl5 IS nof ~5so"MI to lho v.1IH~MY 0' C.,r/1f!c,lto 01 ReftMso 01 Fodor.l1 Tolll IlDn Re\'. Rut. n...t6, r9".2 C 0 4091
PART 1 . RECORDING OFFICE
Form 668 (Z) tRev 8.97)
CAT. NO 600261
Departmenl of tha Treaaury . Inlernal Revanue Service
Drm 668 (V) (cl
~ev, October 1993)
Notice of Federal Tax LIen
listrlct
Serlai Number
For Opl/onel V.e by Recordlnll Olllce
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As provided by secllons 6321, 6322, and 6323 of Ihe Internal Revenue
Code, we are giving a nollce that laxes (Including Interest and penallles)
have been assessed against Ihe followlng.named taxpayer, We hava made
a demand for payment of this liability, but It remains unpaid, Therefore,
\here Is a lien In favor of the United States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
addlllonal penallles, Interest, and cosls that may accrue,
lame of Taxpayer
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lesldence
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IMPORTANT RELEASE iNFORMATION: For each assessment listed below,
unless notice of lien Is reliled by the date given In column (el, this notice shall,
on the day following such date, operate as a certificate of release as defined
In IRC 6325(al,
Tax Period
Ended
(b)
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Kind ofTax
(a)
Idenllfylng Number
(c)
Dale of
Assessment
(d)
Last Day for
Reflllng
(e)
Unpaid Balance
of Assessment
(f)
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lace of Filing
Tolal $
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his notice was prepared and signed at
. on this.
Ie
, , day of
.19_,
;gnaturlt'--_"~r-';~;:-F' I Title
I oWell aU\llorlZ81...b~t~ak' acknowledgments Is not essential to the valldlly 01 NoUee of Federal Tax IIln
2 C,8, 409 ~'In_
- Part 1 . Kept By Recording Office Form 668 (Y) (cl (Rev, 10/93)
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