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<br /> <br />Form ~CO Department a# the Treasury - tnterna! Revenue Service <br />CRev.seplemteri978} -~; ..Noti~~_of Federal Tax Lien Under Interne! Revenue Lags <br />District ~ ~ Serial fvumber ~ r~, c,>r,ansr use br .Reoo`e:r,9 drrwo _ <br />I -- <br />As provided by se~-tiQns 632f, 8.122, and 5323 of ±:`e Interne! Revenue Code, j <br />e.:,i~e is g.~ven that iaues (including interest and p?ra:[ies? have men assessed <br />against the following-nam°d taxpayer- Demand for rayment of this liability has ~ <br />peen :wade. 4ui if rema-tns unpaid. Therefore, there [s a lien in fever of the Unlted <br />Stites on ai6 property and riyhis io prope,~ty belonging to this taxpayer for the <br />amaunf of these tales, and additivnai penaiiies, dnterest, and costs that may j <br />aacnee. ! <br />Name of Taxpayer <br />fteflCe <br />K'qM d 7az Taz Perfod Ended I gate of Assassmertt <br />to ~ tai ~ icr <br /> <br />idexttityirg Number ~ ~ Assassmani <br />(a1 tU <br />-,.~- .,- .r~. I .,.~: <br />Ttftts tfDflOB YYdS ai4d SignEd 8t - - - `~ t _: ~sY`a;E_>3 <br />Iotai 15=~~.7i <br />Ort this, <br />xe 5~~+ ~ i rile <br />_ ~ 'xs s;nn<. ra;. ;gsc ._. ;.cs s~arrrta6~sren~u~ ~-.a ~-en;-n, :~ :ne va'rBnr at hra~e at <br />Fr~r~t Tta Lwr fi.C_l1. ~raa, rp5:, ;. C & ~?5! - <br />Part 1 - Ta be kept by racerdarp oftiee Farm 668 ;Rev. 4TSS <br /> <br /> <br /> <br />