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<br />Form ~a Dapsrtmant of tha 7reeeury - Internt.l Revenue -f:rvice. <br />(Rw.~SLp[emDw/9Y8~ Notice of Federal lax Lien Under Internal Revenue Laws <br />District i Serial~Number ~~ '=or opaonar we oy se~ordrng once <br />i <br />_ i 41045 <br />`~% <br />As provided by sections 6321, 6322, and 6323 of the internal Revenue Code, <br />notice is given° that taxes (including interest and penalties) have been assessed <br />against the following-named taxpayer. Demand for payment of this liability has <br />been made, but it remains unpaid. Therefore, trlere is a lien in favor of the United <br />States on all property and rights to property belonginy to this taxpayer for the i <br />amount of these- taxes, and additional penalties, interest, and costs that may <br />accrue. <br />Name of Taxpayer <br />Residence <br />jC ,. _ v_ <br />8~-{~~~24?4 <br />- <br />Kind of Tax i <br />(~} I <br />Tax Period Ended !'Jets of Assessment <br />(61 C (cl <br />F <br />Identifying Numtxr <br />ld; ~ <br />_- Unpaid Balattcs <br />of Assessment <br />Ce) <br /> 1 <br />i <br /> <br />I <br />Place of FNin9 <br />ti f ~~ . _ _, Total <br />s _ ~ _ , _ ~..._~ ~I i ~ "_ ... <br />This notice was fxepa'ed andsigned at - - - ~ , on this, <br />the~_ day Of ~-~ ,19 ~ ~~ <br />Signature <br />- _ • „ <br />w ,Title -- <br />fIJOi~: Carfihcafs of ollicer authorized hi law ?c fake ecknow.~etlpnpnfs is .n o! e:Senfi,af to the vJli[liiy c/ NoflcO of <br />FW~r~f TeJ Cien G C Af 26119 395P~. G.B 125_) <br /> Part 1 - To be kept by recording offace Form 666 {Rev. 4 ~a7 <br />k <br /> L.~ <br />l_.`_ <br />