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, Department 01 tho Treasury. Internal Revonue Sorvlce
torm 668 (V) (e) r~otlce of Federal Tax Lien
Rev, October 1993)
)lstrlcl Serial Number Fa, Opl/onal Un by Raco'dlng Ol/lee
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As provided by secllons 6321, 6322, and 6323 of tho Internal Revenue
Code, we are giVing a nollce Ihal taxes (Including Interest and penallles) FTL
have been assessed agalnsllhe followlng.named taxpayer. We have made "-"
a demand for "aymenl of this liability, but It remains unpaid. Therelore, - r.;:
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there Is a lien In favor of the Unlled Statcs on all properly and rig his to ~J
property belonging to this taxpayer for the amount of these taxes, and -
addlllonal penalllcs, Interest, and costs Ihat may accrue. N
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~ame of Taxpayer , . _ "j' , ,.', .,. UI
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! IMPORTANT RELEASE INFORMATION: For each assessment listed below. 1/C].UOp,J
unless notlca of lien Is reflled by the date given In column (e). this notice shall.
on the day fOllowing such date. operate as a certificate of release as defined c.<<-" l;:,1 oj '-11
In IRC 8325(0). IttJ )""1c".
Tax Period Date of Last Day for Unpaid Balance
Kind ofTax Ended Idenllfylng Number Assessment Reflllng of Assessment,
(a) (b) (c) (d) (e) (f) ,
11.1-1(1 l. .1 '-',' , " " . 1 , l
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l':J,ll) 1. ! .' J '" \, ( , " ' , ; . I", 'I" .1'-, .
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~Iace of FIling
"': 1."1'," Total $
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'hls notice was prepared and signed at
he ' I " day of
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llgnaturll'--_"'_. '~I'\...W\,;". ". ,
Title
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I olllc" .Ujho,lz b~l.k. .'kn.wl.dgm.nl,I, n.1 ....nll.ll.th. v.lldlly 01 Nolle. el F.d.,.1 Tu II.n
C,O, 40 /,,:
...... I Pori 1 . Kept By Recording Olllce Form 668 (V) (e) (Rev. 10/93)
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