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Oeporlmenl ollhe Treasury. Internal Revenue Service
Form 668 (V) (c) Notice of Federal Tax Lien
(Rev, October 1993)
, Serial Number For Option.' Use by Recording Ollie.
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I AI provld.d by IIcllons 6321, 6322, and 6323 of Ihe Internal Revenue
COdl, WI ara giving a nollc. Ihallaxes (Including Interesl end penallles)
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I have b.en a.....ed agaln.llhe followlng.named laxpayer. We have made
. d.mand for paymenl of thll lIablllly, but II remains unpaid. Therefore,
th.r. II . lien In favor of the Unit.d Slales on ell properly and rlghls to
I prop.rty b.longlng to thl. texpay.r for Ihe amounl of Ihese laxes, and ,
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, Iddlllonal pen.III.., Inl.r..I, and cosls Ihal may eccrue. ,..
iName of Taxpayer
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IMPORTANT RELEASE INFORMATION: For each assessment lisled below. tl'IU._\l' '.n
unless notice 01 lien 15 refiled by the date given in column (e). this nolice shall, ,.", I , ",' il.~ dl
on Ihs day following such dale, operate as a certillca!e 01 release 05 dellned
, In IRC 6325(0), l)l'l",'1J
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, Tell Period Daloof Lesl Dey for Unpeld Balanc.
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, Kind of Tax Ended Idenlllylng Number Assossmenl Rellllng of Aue..ment
i (a) (b) (c) (d) (e) (f)
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Place of Filing
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This nollce was prepared and signed at
, on Ihls,
'he ...JI~.,~L"""",_ ,'r"l'lll,.".,1.9_~
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Part 1 . Kept By Rccordlng Of lice
Form 668 (VI (01 (Rev, 10/93)
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