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Foam ~~~;- <br />(Rev. Sept~amti <br /> <br />Department of 4heTvaasary - Mteme{ nmvenue Servkm <br />ems,! Nfltice ~f Federal ~'ax Lien Under Internal Reveraa~e-~.~wrs <br /> <br /> <br />Str1Ct. ___- <br />$enal Number <br />-FOr Optional~:Webyaecwtling aifke <br /> <br />As pr vided by sectiarrs 6321, 5322, and-.8323 of the Intemai Revenue Code, <br />not' <br />is given that taxe <br />(ir <br />di <br />l <br />i <br />t <br />st <br />" <br />, <br />s <br />tc <br />u <br />ng <br />n <br />ere <br />. and penalties} have been assessed <br />agaiir~ the followrny-rsamed taxpayer. Deanan`d for payment of this liability has r~ ~!t ~ ~[];~ <br />beefrrAade, but {t rerifains unpaid. Theeefo:°e: there is a lien in favor of the United ~ <br />L tl c7 <br />~ <br />State4.on all properl4r.and =sghts to property belonging to this taxpayer foe the <br />amouc~ of these taxes, and•-additional penalties, interest, and costs that' may <br />accrue. . <br />Name of Taxpayer <br />.., ~ ~,: } <br />_ ,i- I <br />Residence <br />7' <br />~~' <br />•i <br />__ ' <br /> <br />Kind of Tex ~ ~ <br />Tax AeNod' Ended ~ F3afe of Assessment <br />Identifying Number Unpetd Balance <br />of Assessment <br /> <br />F <br />.. I <br />., .. <br />.-,- <br />< ~ ~,1 } s~,:;~ <br /> ° <br /> <br /> <br />} <br /> <br />9 <br /> <br />I ,t _,,, , <br />!! <br />f <br />l <br />y[ <br />' <br />{ <br /> <br /> <br />~ <br />. ~cw r.a ~ ~ <br />, <br />,~. ~ r. i 1 Total 1 ~ ° ~ ~~~ <br />. ..._ a - - _. ._. __. 1 <br />__ ~ <br />TlZi;not{tewaspfeParedandsignedat +F`.,,> _<~:_.:. .._,~._-_~__ ,on this, <br />the ~' "• day of -4 -- .t 9 , '~ <br /> <br />gltiatu~~~` ~~'4~~~~ I Tst3e <br />{P1o4w Cnn,fiCalm of otricmr anfh0 rayd br law to take actutom/atlg areas is nw assan7iaJ ro,. the validNy ar- Noikp-or <br />FepRrad.7tx t+an 6,C:M.2&A.79, 7f r5f1-t, C:B. t25.? <br />Part 1 - To be kept try retarding office Form 5f38 iRav. 9-~eT <br /> <br />~.J <br /> <br />