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Dlparlmlnl cllhl TIIDlurv . In lema I Rlvenul Slrvlel
Form 668 (V) (c) Notice of Federal Tax Lien
(Rev October 1903)
Olslrlcl Serial Number Fo, opr/on.' v.. by Rleordlng O/llet
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AI provld.d by IIcllonl 6321. 6322, and 6323 01 lhe Internal Revenue
Cod.. w. .r. giving. nollc. Ih.ll.xel (Including Inlerest end penalties)
h.v. been .......d eg.lnlllhelollowlng.named laxpayer. We have mode
I . d.m.nd lor peym.nl 01 Ihll lI.blllly, bUI It remains unpaid. Therelore,
\ Ih.r. II . lI.n In I.vor ollh. Unlled Slalel on 011 properly and rights 10
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, property b,'onglng 10 Ihll lexp.y.r lor Ihe em aunt 01 Ihese laxes, and
, .ddlllon.1 p.nelll.., Inl.r.el. .nd cosls Ihal may eccrue.
'! Name 01 Tsxpayer ,.' , .
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, 11'1 I."" r,1
i unless notice of lien Is refiled by Ihe date given In column (e), this notice shall,
I on Ihs day f~~~Wlng such dale. operate as a cer\lllcate of release as delined \. ~ \ ,\ I I ", ' fL' I
In IRC 6325 a . ",p "L I'll
j T.x P.rlod Dalo 01 Laol Day lor Unpeld Belenc.
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I Kind 01 Till End.d Id.nllfylng Number Au.ssmenl Ref/ling 01 A.....m.nl
! (a) (b) (e) (d) (e) (I)
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Place of FIling
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This notice was prepared and signed at
, on this,
the
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Title
Ihorlud bV law 10 lake ackntJ'I'l'lt'dgftlllnll II nol tlsenli.llo Ihe ~.hdIIV of Noll" 01 F,d.r.1 Tull."
c.e.4e91
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ParI 1 . Kept Ily Rccordlng Office
Form 668 (V) (c) (Rev. 10/93)
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