HomeMy WebLinkAbout96-00871
Oltpartment of the Tn.1sury. Intornal ROl/onue Sarvlca
Form 668 (V) IC) Notice of Federal Tax Lien
(Rav, OC!d)dr 1(.)9]\
District Senal Number Fa' Optional U.. by Reca,alng Olllco
'. . .. , . I\L <Ill, . :)71
A. provided by ..ctlon. 8321, 8322, and 6323 at the Internal Revenue , fTL
Code, we Irl giving a notlcl that t~xes (Including Interest and penalties)
have be.n assess.d against the following' named taxpayer. W. have made
I demand ~or payment of thl. liability, but It remains unpaid. Therefore, (-' , --~,
therl I. I lien In favov of the United States on all property and rights to 1,1 "
property belonging to this taxpayer for the amount of these taxes, and - ..., . ,
,
Iddltlonal penalties, Interest, Ind costs that may accrue, " ..,
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Name of Taxpayer ..-. , I
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Residence .1 , :.t:; .. - - ''''lhl
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, lIq,O()\,'\
unless notice of lien is refiled by the date given In column (e), thiS notice shall,
on the day following such date. operate as a certi!icate of release as defined c,.... '" \\1':-''1\01
In IRC 63251a), ".~ ~,..,
Tax Period Date of Last Day for Unpaid Balanc.
Kind of Tax Ended Identifying Number Assessment Reflllng of Asaassment
(a) (b) (C) (d) (e) (t)
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Place of Filing
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,on this,
ThiS notice was prepared and signed at
the
day 01
,19_.
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Signature \;[ Title . , : "".-"
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{NO;1~,~'.i"M.:ar:o)lt'Sj~ .'1~CU UJ '.'.., G IMd J .~I.__..~II3'~ ~,ni,'t, Ii not aHtlnllJllO thi valldlly of NOllClt 0' Federal TIX Illn
A"'- Ff~j""7t:<1f6~/l (71 ~..sB 4 J J
Part 1 . Kept B'I Recording Office Form 668 (Y) (e) (Rev, 10/93)
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