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1--- <br />I <br />Form :~. <br />ccav Sec~emt>er~Y <br />f OegartmerTS or4he Trea~ory - Intamei RevtSnue 3rirvi~a <br />tii (+ffltice et ~etlG~'ai Tai( Lien llatde~ Internal Revenue.: Laws. <br />r ~ <br />Dss"trirl -c « ~ ; -, $eriaE Nttntb6r i Far t3pttoear Uaii by Recardtng tlffiatr <br />~ <br /> <br />As Pravadad by se, ti[srts~ 5321, 8322, and 6323 ofi%the lnterna4 Reuenue Code. <br />natica is gbleri that takes ;incfudmg interest and penaEtiesl haue been assessed <br />:against the Faiawing-named,taxeayer. Demand=for payment of this liability has <br />taeen rnade.~b~rt it remains t4npaid. Therefore, there is a Fiery in favor of the United ~ <br />States on all ixapeny and sights '.a-properly belonging to this taxpayer #or the <br />aisrtaunt al these taxes; and additiona# penalties., interest, and casts that may i <br />BGCrUe. <br />Nante of Taxpaeyer <br />L ~~ ~~ ~ :t7~ ~c>~~v«~~crn .:rte ~r ~~~1 ,~ _ aicn <br />y- <br />Residence Ptah ~~ ~ ,, _, ,, k <br /> <br /> tii~l8id 881tNiC9 <br />!Cipd of 't9uc ~ Tax: Period' Ended Gate tN Assessment Identifying Number of Assessm~tt <br />{e) r ib) { (cl ~ 1tl) {e) <br />44 -<~~ i~iu~3 1 1-%5-.rte ~7 y =>7-r ~~2~63 ~•':6.~a;~ <br />~- ~ ~~,~ v~~5 1 ;~5_r" "~1 ~ :~r-~d~zo5; ~, '3.31 <br />, <br /> <br />~ l <br />--~`~ <br />C,-hG COQ" <br />C75-1`~-4~1 <br />i <br />i <br />~' ~ _ 1~7-06J2~v3 1,4.?3,25 <br />r~laceotrmng <e~ t~~_ c%~ ~1~:,a~;Y <br />Total Rio F~nl,j~ <br />This notice was Prepared and signQtiat d_~ ~ ~rtdr "'~£:CT'33f*~ , on-this, <br />the=2;~ daY c>f _ 9'.;i"L:3 .1$ ~'~t <br />,~ <br />9igna~ure4};~ ~~ - --~-Title <br /><tiot~ Gar..l;u.e of a4tlCer. authorized oy law SO take ackaowtedymenls rs not essorstial is the validity o1 Naalce of <br />Fsdera! Ta. L+a:l G.C:Td, Ytiai 9; 795b Y, C.B. t25} <br />'?art t - To t>e kept 4y recording. office Form &68't€€ev, s-78) <br /> <br /> <br /> <br /> <br />