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<br />`~ r~ _ . ; - _ Dcoarcmene W trye Treasury- lntarnat Fievanue Seevtao <br />~~iD ~ ~_ N~itc~ of ~ederaB Tic den Under internal Rev~~~e La-~s <br />,Rav_ Septamner t 127871 - - <br />~~___ <br />~I:1iTIS:~ y S0r1al 1`tvrT4ber ~ For opeiona+ use Ov Axo'Ci rrg 1Jrrica <br />u t y - 's i - <br />/+s provit9ed by sections B32t, 6322, and 5329 of ?he fntemaf Revenue Code.. <br />notice ig given that :axes ;including ;nteres'. and Penalties) have been assessed G2 e,~~ ~ ~ ~ 39 <br />against the follctiistg-iaruad Taxpayer, Demand far payment of th+s tiabillty ttas ~ G <br />been oracle, trof it remains unpaid. Theretc,re, there is a !ien ;n flavor of the Unifed <br />States on atI prcaertY and rights to Property beEeng4ng to th+n taxpayer for the <br />amount of thEesee taxes, and additional penalties, interest. and :;osfs that may <br />accrue. <br />Name a1 Taxpayer <br />--~--- ---_ r~ _ _~._ _ <br />Residenr~ <br />i Unpaid Balartca <br />KJrtd of Tsa Ta: Partob E'ndcC f Date of ,4ssauenstit ' itieaUfying kvtrtt>st of Assessment <br />;aa ~ rm ' ;off I cap r«~ <br />_ ' - --r--- -j-- - <br />+~~ - ~ - <br />I <br />~ ~ ~ <br />.,~~ u.-17 y_.. _, ~:u _ <br />Iola) J i " c. <br /> <br />,. <br />_ ... <br />TAhnothtewssPrrrAaredsnda+9nedat_u= _:----:.-~, .--~ i `=--- _.__.___.._. -.--.--.._.___,._~,nnthis, <br />iha~ .:.;; :. ~y of ~>.., ,, ~ t 9 ~.~ <br />Signature ~ 7stfe --~--- <br />[MwK CM'a1Y-114 d i/tr~taY i4f:tW~SM fli' !a. tC f]a~ aCXniS~ladgm<n:Y i5 :~Ot e-,.yrnl•Br r0 frn ': a/MrtY O% NOtMb O! i <br />FaOMai Tai Lran 6.a:. M.?NYR tY34 f, C. B. :?S.J <br />Part t - To ba kept by rccordirtg o#fica Foam fi6A ;Rbv sas) j <br />1.~, <br />