HomeMy WebLinkAbout95-04673
Form OOO(Z)
(Rov,S'91l
Deportmont 01 tho Troosury . Intornol Revenue Servlco
Certificate of Release of Federal Tax Lien
District
Serial Numbor
"f., Nr~"lt V/ll-j I h I' 1 ) '
I cortlly that tho lollowlng,nomod toxpoyor. undor tho roqulroments 01 secllon 6325 (0)
01 tho Internal Rovonuo Coda hoo sotlollod tho taxoo listed below and 011 ototutory
addlllons. Thorolore, tho lien provided by Code oecUon 6321 lor thooe toxeo and
addition 0 has bean reloooed. The proper olllcer In the olllce whero the nollce 01
Internal revenuo tax lien was iliad on {, .,. I'" I ,
I '," r, Is authorized to note tho books to ohow the release 01 thlo lien lor
theso toxoo and additions.
Noma 01 Taxpayer
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Residence
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Dote 01
Assessment
(d)
Kind 01 Tax
(0)
Tax Period Ended
(b)
IdenUlylng Number
(c)
1 040 1 , I , 1 , I if:} 'I 1 ,r3 - . " II,: " 1 I 1 ; ! ~j :Jl,
! 1140 I c' i " 1 I q~.' :: ,oj , , 0, I 1 .,' J ! II , : ! II'}l
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Ploco 01 Filing
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This notice was preparod and slgnod at
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For Usa b Rocordlng QHlco
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Total
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Lost Day lor Unpaid Balance 01
Rellllng Asoeosment
(e) (f)
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. on this.
PAnT I ' nEcORDING OFFICE
(llOlE' C'('ff<!I(',1/o of ol/JeN lIulhcr;/II{/ lly I,m' to ",10 lIC.\110l,lL'dOmCfll' is 1101 f'u!1"""I,O /fIll "'''/IIMy 01 Cll,Mc::Jto vI IllJlt'.ue vI FtldlU;J1 Td./lon /lIlV. Rul. 7''''60. '91'.2 CO. <f09)
Form 66& III InDY 6,97)
CAT, tlO 600261
Deportmont 01 tho TreOlury. Intornol Rovenue Service
Form 668 (V) (e) :;)'10
(Rev, Oclober 1993)
District
Notice of Federal Tax Lien
Sorlal Number
PI.' ".1",..1,1", P^ ":"'.11".1'.
As provided by sections 6321, 6322, and 6323 01 the Interna' Revenue
I Code, we ore giving Q notice thottexes (Including Interest and penalties)
I hove been assessed against the followlng.nomed taxpayer. We hove mode
i a demand for payment of this lIablllly, but It remains unpaid. Therefore,
'I there 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 texes, and
I additional penalties, Interest, and costs that may accrue.
Name of Taxpayer 1:'[_ NNElli F HE:.LSl nON
I Residence
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Fo, Opl/onol UIO by Roeo,dlng Ollleo
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IMPORTANT RELEASE 'NFORMATION: For each assessmenl listed below.
unless notice of lien Is reflled by the dale given In column (e). this nollce shall.
on the day following such date. operate as a certllicate of release as defined
In IRC 6325(0).
Tax Period
Ended
(b)
Kind otTax
(a)
Identifying Number
(e)
,
,
I 10-10
I 1<1-1 (I
, to-10
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I 10-1(1
i 10-10
I 10-10
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1 :':I;:<I/Cf(
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1;~/31/90
t;':/:~1/91
1 :':/31/9;;:
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1 :=J7 -l;6-0,;:'\ \
1 wr. 5',.-'0;;:11
18'7' (;;,'.- 0;'.'1\
113'r-!:;6-0;;'11
187-b6-m,11
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iPlace of FIling
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Data of
Assessment
(d)
1"1,',1 ;;: I ")l:i
II,;:I,;:1/9l5
o~;:I;;:II'){:f
11;::/;': 1I')t;i
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:Thls notice was prepared and signed at 1'1. ii', ,i. I I't, t.. I'A
,
Title
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bq,c'O f,d
C.'" liJ,';'I5
Rll ;)'1:13'\
Last Day for UnpaId Balance
Reffllng of Assessment
(e) (f)
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O:=t/;~''}/(I5
(I::t/;::'}/(Iti
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Totol $
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(NOTEI Corllflel'o 01 ofllel' .ulho,lzed by I.w 10 I.k. .eknowl.dgm.nlll. nol ....nll.llo th. ..lIdlly 01 Nolle. 01 F.d.,., Tex lI.n
R... Aul. 71.400. 1971 .2 C,D. 409)
Pori 1 . Kopt By Recording OIllCD
Form 668 (V) (c) (Rev. 10/93)
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