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<br /> <br />per, ~~~ ( .. - _ ~„, Depa+tmerti Af fha T: eesury-1Mernel RevenueServica <br />(Rev. :.eptemDa. t9Y8}~ ~lar~ICB Of Federal Tax Lien under Internal Revenue Laws <br />district ~ SeriaFNumher ~FOr op,onal ~~a a~ ftanm,ng nmoa <br />-_ --i_- - <br />Els provided by sections 8321, 6322, and 6323 of the Internal Revers <br />notice is given fhaf taxes (including interest and penalties) have been assessed <br />against the fol;owin~amad taitpayer. damartti' for payment of this liability has , <br />t3een made, tx:t it remains unpaid. Therefore, there is a lien in favor O# the United ! ` ~ .~ ;~ L+ `~ '; <br />States on al". property and nghis tc prcrerfy taetcrtginq to this Taxpayer #or the ` <br />amount of shese !axes, and additional penalties. interest, and. costs that may <br />accrue. <br />r <br />Ptame od Taxpayer 1 <br />~__ - .... __._ ._ J i. <br />Unpaid BitallC! <br />Kind of Tan ! Ta: Period Ended Dates of assessment j tdstttitying NtMrlbsr of Assessment <br />a3 ~ cam: ; ~, .r,, ~ f.1 <br />---;---- <br />} <br />I i 1 <br />I <br />l <br />Place o! f=da14 <br />Thos natfca vMaS prapar6d and signed ai ,> ,;..: ':. , ~ _ .. _:.;; <br />____.- _ ----------_---- . on this. <br />thp_=~_' day Ot - - _ , t 9 <br />(l~wC CMtilitiafa ~! W+'a Dr rYrnorrtt.p v tv .'a4~ ~LKnO,Yf~QQ.~rt: M1 ra r!t! wYlsr~frd: f0 ~ha v!1/rJNY p/ NOfIGa Ol <br />FwOwaf ra,< C+w G,C Y. 264F9. f41a-r. _. R. ~ZSY; <br />Part t - To be kept by recording office from 68i'(Rev. 476', <br />1 <br /> <br />