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<br />Fprm ~s~ ~ 6e~partmen: of the Treasury - Inierna{ R9ven'ue ServicB <br />lP.ov. GepfemDe ;BTFi}~ N~tiCe of Federal Tax L~~~~ Under internal Revenue Laws <br />i <br />taistrict SenatTJumber <br />- ~ For Optlcne! Use ay Racaraing Office <br />L ~~ _:~ ~ 44913 <br />As provided by sections 6321, 6322, and 6.423 of the Interrtal 'Revenue Coda, <br />notice is given that taxes tinduding interest and penalties} have'beerc assessed <br />against the following-namzd taxpayer. Demand for r~ayment of this Siabifity has ° ~ ~ t -- ~ <br />been made. but it -emains unpaid. Therefore. tttere is a Tien in favor of the Untied ~j2'~'~ {- '`' = `~ f3 <br />States on all property and rights fa property belonging-to this t~xpayerfor the' <br />amount of these taxes, and additional penalties. interest, attd <costs thati may <br />accrue. <br />Name of Taxpayer - <br />Residence _ <br />Kind of Tau i Taz Period ~ndsd Date of Assessment Iden Unpaid 8alnroe <br />t•~ i ~ ref i tlfyiryl Num!»r ~ of Assessment <br />'--- i rcl j (d (el <br />~ _ <br />~ i <br />i <br />of F8h-g ~ <br />~1s.,, J-, - __, <br />~.ri)i~~Lj .. ~._. <br />'rMs notice was Prepared and signed at _ . '~..<_~_ __ . , .., . _ . _ <br />Total ~ _ , <br />on ths, <br />the~~}vii day of __:' .'9 "= <br />-- -- - -- <br />- Signature -- ---------- - - - ---------- ----- - --- ----- <br />Title <br />+~1r0I~1J Tc. ~---- <br />{Mott C•.rrn;c•fe or orrKOr .ulerrr: ec G.' , .. 'ak• resncwredymenr .- <'~ <br />F•dK•I Tai Lyr, G C.M. ?6'19. 'flSlUl. C.3. ]~?,~ ^ ~ is gnlral .•^ t!r• validity C! NO[rce vl <br />~ Part t - Tv bB keRt by recording office Form 86d CRev. 9-7x7 <br />