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_, .._ <br />OzCartment of the Treasury - !sterna! Revenue SarvlCe <br />Fam 6~8 ~ i NoEice of Federal Tax Lien Under internal Revenue Laws <br />Irae~. September 19787 <br />- ~ ~ For Op4lane! Use by kecording Ofnca <br />Dtstiict ~ Serial Number - <br />409^02 j <br />r_~~ :,~ ~ `~' <br />As provided by sect;ans 6321 6322, and 8323 of the intemat Flevenue Code. i 8 ~ ,_,r j) [~ `~ `J ~ ~j <br />notice rs Siv°n that taxes ;rnc!uding interest and penaltres) have beeq assessed <br />against fhe tollowlrg•named taxpayer.. Demand ?or payment of thrs ltebifity has , <br />been made, but it remains unpaid. Therefore: !here is a lien in favor of the United <br />ates on al( property and rights to property be!enging to this taxpayer for the <br />amount of these taxes, and additional penalties. interest, and costs that may i <br />accrue. <br />Name of Taxpayer <br />Residence ~ <br />a _. - <br />1 - <br />- i Unpaid Balance <br />Ki[-d oaf Tea 1~ Tas Period Ended ~ Date of Assessment ~ Identifying Number ' ot!-ssessment <br />I- <br />I ~ _ _ i <br />1 f I <br />Place of FiOing <br />i <br />~~~ Total i ,~. <br />This notice was prepared and signed at -- - -- ---------~ on !his, <br />the _ ' day of .19 ._ '- ' -- <br />----- <br />------- <br />- - --- <br />Signa~ure ~ Title <br />- ~` <br />[HOI~ C b o [I+~Or nw tad av ~3w to !e1~0 eLksx~WtIW9mBn1= ~~ n0! OS ~r::~el ?o ','re valitli:y Q: Np(icc of <br />Fod~ra .ex L;en G.C.M. 26!9 t95C '. C.B "25.7 <br />Pert 1 - To be keel bV necordirzg office Form 868 (Rev. 9.781 <br />1 <br />t <br />~~. <br />