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<br />O~pertmaRt:ot the Treasury - Irrtemai Revenue aervu:e <br />Form ~ - ... ~.. - ,,, - - <br />" i~,.Fae.,~3, `=~1 a#~~_ 1 Tax Lien ~lnder Internal Revue Lam <br />---~- - - ~ 5aria~ Number- -~ Forr~pncawuaeAi~Ae~r~~e- <br />t)iatci~ -t,, n ,. 3 .' ~ 459Q4 w . ,, ~ .. - - ii - ~~, ~ <br />s_ , .. ~ <br />~.pvvMad-hy saci#one fi321,8322, and'8323 at the iflternaf Revenue Dade; <br />notite is~yiven the taaas (trteludk>,g interesn aria' penaties) tiava,besn <br />aasssaed ;., at:Yat tfie tatlowirrgl-Hearted taxpayer. t7emand far payment at ~ <br />tails llabiltty beers tt~ldei kuat it rtaenainsunpsid.'~h~refore, there is ailen <br />in favor of the Untied 5tatea an all property acui Mghts to property beksngfng <br />#a thla;taxpayer for tfie amourrt of these taxes; afxi addit onal penalties, , <br />Iniareet; and caatathat may accrue. , x, <br />- Name otTaxpayer _ -- --- - y } ; t ~ '• <br />Residence ~---~__._.~___-_~-_._.__ ---i <br />IMPDAT,4NT't$1,EA8E iNt~FtMAT{ON; Wtih respect:to. seen tl~ee5ment ll$ted-t,elow.. unless <br />.rmtice of lien is retda0-Try. lhe. data y.!veR fn :.oiumn (e), this notice she#l, on the day btlowing. ... ,. ~._ <br />runt date. apeTate-asaseEtiirca9ao(j9iprise as deNnedm-iR6 S925iaT~ _ _ .. - <br />Taxlod ~ { Date of ~ East Day for ~ ~ llripald 9a(Igitx - - <br />,Kirri tit Tait Ended i identifyirng Numiaer i Aasesarrren6 i RBPFIirtg of Assessment ; - <br />I j <br />- -. - - i. - - { ~ - , <br />I' ~ j ~: <br />} ~ 1 <br />,.. l . ~ <br />I: <br />_. ~,.. .., - i. - _ . <br />si f <br />I <br />__. ~ ~ - <br />- _ }' -. <br />..j. } <br />f <br />izlBCe O(Fltltig _ ~_ ~_ . <br />,. k~:a5~ c. - - ,Ohfhis, <br />This ntdice+~s ptgpared and signed al - .______ ---------~---- <br />a>i >~ ~...,,_. .- .. - - .. - <br />t~e,,.,~,~dayoi ,a9~_~ - <br />T"nie <br />x <br />t[tat'E: GaealECaxoraAKw eedMnzuoroY lar+m tek~o ndr+ow+ed4+nar'~b.s trot esaentem to R+e raxWry otNaaee atfa0e~af Taa Lren -___.___._.._~ <br />FW. FArt. 7z-45& t4tt~2. G.B. +OSj <br />Fart t - To b8 i.Cpt by Rtt'G4rdinQ {kttice Farm aaal~ tRev. 2.83) <br /> <br /> <br />