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Olslrlcl '~sorIOI Number For Use by Rlcordlng OlllcI
I cer1l1y thet es to the lollowlng.name taxpayer, the requirements 01 secllon 6325 (a)
01 the Internal Revenue Code have been sallsfled lor tho taxes listed below end for
all stetutory eddlllons. Therelore, the lien provided by Code seellon 6321 lor these
taxes and addlllons has been released, The proper ollleer In the, olllee where the
nollce 01 Internal revenue tel lien was lIIed on ,___., ____
19 . Is In authorized to note the books to show the release 01 this lien for
Ihese lales and addlllons
Name 01 Talpayer ' " :
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Unpaid Balance
of Assessment
(f)
Tal Period Date 01 Last Day lor
Kind 01 Tal Ended Identifying Number Assessment Refiling
(a) (b) (e) (d) (e)
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Place 01 Filing
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Form IIIlZIlAov &0",
CAT NO IOQ2tl
HAl' ' RECORDING OHICE
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',', Department olthe Treasury. Internal Revenue Service
Form 668 (V) (c) Notice of Federal Tax Lien
(Rev, October 1993)
District Serial Number Fa, Opl/on.' Us. by Recofctlng OlllcII
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As provided by lectlons 6321, 6322, and 6323 of the Internal Revenue ' ). (;Cd :)
Code, we are giving I notice that taxes (Including Interest and penalties) FTL
have been assessed against the followlng.named taxpayer. We hava made
a demand for payment of this liability, but It remains unpaid. Therefore,
there Is I 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 ''''>
additional penalties, Interest, and costs that may accrue. 'n
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Name of Taxpayer "t-;.;.1i !I Lf,i\l'J' 11-:_ r"._,
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Residence :.-:IJ{.", ,'I,\!,J[i .:1 <":,
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IMPORTANT RELEASE INFORMATION: For each assessment listed below. ..0
unless notice of lien Is refiled by the date given in column (e). this notice shall. 11C\'l.'L'i.<1 .."
on the day following such date. operate as a certificate of release as defined (v tl 'S"1S~ 1 l<.u 1.'Y1 t.R
In IRC 6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind ofTax Ended Identifying Number Assessment Reflllng of Assessment
(a) (b) (e) (d) (e) (I)
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' .
Place of Filing
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':i,,' I,. Total S ,
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This notice was prepared and signed at
. on this.
""...~;w..
Ihe day,f.~;l'!;'~' .19 "
Signat~:,../:.. ~/
(NOTE: C.rtUlCI'1 oromelr authorIzed by law 10 tak, ackno"",dgmenllI1 not ..ltntll' 10 thl Vlhdlty of Notice of F.d.,al TUll.n
RIV, Rul, 71.488. 1871 . 2 C,S 408)
I Title
Part 1 . Kept 8y Recording Olllce
Form 888 IV) Ie) (Rev 10/93)