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<br />scan ~~' ~ + De parrtank of khe.Tr9asury-i~taenalRavenuB SarviCe <br />;~e. s~t~r.,~„~,a;} _ ~N~tieee of ~edera9 ~'ax Lien Under Imt#ernai Revenue Laws <br />District ^-1 ;Serial Number PoT opnona/ u5a or Rexord;r,p cnrco_ <br />$2-- i1ti1;~5U <br />{rs provided try sections .8321, 6322, and &323 of the infernal Revenue Code, <br />notice is given that taxFS (including interest and penalties} have been assessed <br />agairsi the fallowing-Warned taxpayer. Dea:and for payment of this liability has <br />been made, but it-remains unpaid. 7here4ora, there isa lien in tavar of the United <br />Stages cn ail property and rr9ttts to property belonging to this taxpayef for the <br />amount pf these taxes, and additi~na! pena!t;es,lnterest, and c~tsttrat may I <br />accrue. <br />Namo cf Taxpayer ? <br />t <br />Residence - - »f <br />_. <br />. _. _ <br />..:., + ,, . , , i <br />Unpaid Balance <br />Kif~ al ta><- 7as Psnod Endsd Date a! Aas~sment tdeotifyfn~ Numt~sr { of Assessment <br />,) ~ ra) :GJ ~~; ~ ;s) <br />- - t _ i - <br />a <br />e <br />f t <br />i ; , <br />I _ <br />Place of Fginq <br />.. <br />Total ~ t <br />_. _ , . . <br />__ y _ I <br />lTft3 notice w!-a preParNd and signed a: - ---- _ _ __ ~_ ~1,_ ' . , _._._~_- , on this. <br />Tlte_ day of _ __ ,19 _''~,_._._.~._._ <br />Signature ~} yL- TK1e <br />~~ <br />..~ -~ - -- <br />fMp{~: can=rICl:s o' ufi,CM ~uMM.l~c] .T :aw rte.. iYkt 1'CknQwl~dpflfrMS is not &yynlnriel r0 the v~/(rJ¢y D/ Ndtb! or ,' <br />GItJ~Yr TIa L,~n Ci v, U. ?R~ t ~. ' YSF'.:.:1. ' 15) <br />Psft 1 - To trs kept by racordrnig office Form 88EI IRcv:4~tg) <br /> <br />