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Dlplrlmlnl ollhl TrI..urV ' Inlornol Alvlnul Slrvlcl
Form 668 (V) (c) Notice of Federal Tax Lien
(Rev. October 1093)
District Serial Number For Opl/ono' V.o by Rocordlng Olllco
Aa provided bV eectlon. 6321, 6322, and 6323 01 the Internal Revenue :U 'h li.Cj,J (" \C-IL
Cod'l we ere giving a notice that taxes (Including Interest and penalties)
h.v. b.en .....lId agalnet Ihe lollowlng.named taxpayer. We hove mode
. d.m.nd lor pavmenl 01 thle liability, but It remains unpaid. Therolore, ,....
Iher. I. . lien In lavor 01 Ihe United States on all properly end rights to ' .
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prop.rlv belonging to Ihl. laxpaver lor the amount 01 these taxes, and
additional penalties, Interest, and COltl thaI may accrue.
Name 01 Taxpayer. (
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Resldance -
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VI
IMPORTANT RELEASE INFORMATION: For each assessment listed below, 1I11.uVI
unless notice 01 lien Is reliled by Ihe date given in column (e), Ihls notice shall,
on the day lollowlng such date. operate as a cer1llicate of release as defined (l.....t\ 11'1'11.',
In IRC 6325(0). l~ l' k 1 elL'
Tax Period Dote 01 Lalt Dav lor Unpaid Balanc.
Kind 01 Tax Ended Identllylng Number Assenmenl Aellllng 01 Allallm.nl
(a) (b) (e) (d) (e) (f)
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Place 01 Filing
Tolal $
This nollce was prepared and signed at
, on this,
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Port 1 . Kepi By Recording Office
Form 668 (VI (c) (Rev 10/93)
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