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,. Oepertmenl olthe Treasury - Internal Ravenue Sarvlce
Form 668 (V) (c) Notice of Federal Tax Lien
(Roy, October 1993)
Dlstricl Serial Number For apI/anal Use by Reco,dlnl1 Olllce
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As provided by sections 6321, 6322, and 6323 of the Internal Revenue ~ lKjlf i=TL
Code, we are giving a notice that taxes (Including Interest and penalties)
have been assessed against the fOllowing-named taxpayer. We have made
a demand for payment of this liability, but It remains unpaid. Therefore,
there Is a lien In favor of the United States on all property and rights to '-
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property belonging to this taxpayer for the amount of these taxes, and -.
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additional penalties, Interest, end costs that may accrue, --
Name of Taxpayer, [; lI'l. i!l L ., " :'q "JI._;::r -
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Residence " tl':F.111 l'h' "
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IMPORTANT RELEASE INFORMATION: For each assessment listed below. '9.C()\,>c!
unless notice of lien Is refiled by the date given in column (e). this notice shall.
on tha day following such date. operate as a certificate of release as defined <-~ t\ <.1rl 39 R,ll 3V5,'!><j
in IRC 6325(a).
Tax Period Date of Last Day for Unpeld Balance
Kind of Tax Ended Identifying Number Assessment Reflllng of Assessment
(a) (b) (e) (d) (e) (f)
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Place of Filing
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This notice was prepared and signed at
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day of
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Signature
Title
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take ackn,)wledgmlnllls not .".nti8110 the valid it)' ot Nolle. 01 Fed"al Tlx lI.n
Part 1 . Kept By Recording Office
Form 668 (V) (c) (Rey, 10/93)
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