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D.plrtm.nl 01 Ihe Tr'8Iury. Inlernel R.v.nu. S.rvlce
Form 668 (V) (c) Notice of Federal Tax lien
(Rev. October 1993)
District Serial Number For Opllonal UII Or Racordlng Olllco
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AI provided by secllons 6321, 6322, and 6323 of the Internal Revenue
Cod., we are giving a nollce that taxes (Including Interest and penallles)
hlvl bean IllelSed against the followlng.nemed taxpayer. We have mode
. demlnd for payment of Ihll liability, bul It remains unpaid. Therefore, ,
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therl II I lien In favor of the United States on all property and rights to ..,
property belonging to thll taxpayer for the amount of these taxes, and
, Iddlllonal penllllBl, Interest, Ind costs that may accrue.
:Name of Taxpayer. i , i " e..
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I Residence :
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IMPORTANT RELEASE INFORMATION: For each assessment Iisled below. 1lCi.l\','\'"
unless notice of lien Is refiled by the date given In column (e). Ihls nollce shall,
on the day following such date, operate as a certificate of release as defined ( ...~., 1I1(ic:-,
. InI006325(ell.l. I 'i., ""'" " .. r, ,\ ';0 /'IC'
Tax Period Date of Last Day for Unpaid Balanc.
. Kind ofTax Ended Idenllfylng Number Assessment Reflllng of Allellmlnt
(8) (b) (c) (d) (e) (f)
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,Place 01 Filing .
, Total $
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This nollce was prepared and signed at
, on this,
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day of
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,l3lgnatu~~_ ... ... ....._. "'I ' ." 10..1 Tille
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(HOTEI_lIleR'e 01 ollleer authorized b~~IO la!l,B Dc!l,nowledgmBnll II nol nsentlal 10 the validity 01 Notlc. 01 Fed".1 lullln
RIV, 1Jil:'"~.4 71 . 2OC.B! 4091 - .~/
."..... .: n>art 1 . Kept By Recording Office Form 668 (V) (0) (Rev. 10/93)
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