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NOTICE OF FEDERAL T AX LIEN Url!)!R 'HTEiUU~O~E~~~~Uf LA~ ~
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Pursuanl to lnf: l'ro':i<,ions 01 SectIOns 6321,6322, and 632301 the Internal Revenue (!:ode 01 19S4, notice IS
hereby qivt'n lhat lhere love been assessed under the Internal Revenue laws oi the Umteri States (}Gainst the 101-
10.....lnQ-nCITlPd t'lXfrayer, t-:Jxes (includinq mterest and penalties) which after dancr.d lor payment thereol remom un.
ped, cm.:l lhat Ly virtue 01 the ahove-mentioned statutes the ClTIount 01 said taxes, tQ,Jether with penalties, Interesl,
and costs Ulat may accruE' In ackhtion thereto, is a lien in lervor 01 the United States upon all property ard riqhts to
property be:onQlnq to smd taxpayer. to wit:
~RE."'. ....Ay ,.,u
OlSTR1CT
NAME 01' TAXPAYER
.- .
RESIDENCE OR PLACE 01' eUS'NE55
NATURE OF TAX
WITNESS my hand ot
the
ACCOUNT NO.
YEAR OR TAXABLE
PERIOO
AMOUNT OF
ASSESSMENT
ASSESSMENT DATE
s
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,,'. ,'........
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TOT A.L
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, on this,
day 01
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. 19-.:.:.....
BY (5ipol"'~)
TIT LE
DI5TR!CT DIRECTOR 01' INTERNAL REVENUE
(Ncyn:: Certlhcote of cHicN authoriz.ed by law 10 ta~e aCk.nowledqments is nol es_r.tlal 10 the validily of NOI\6e 01 Federal TQJ[
Lien, G,C.M. 26419, C,R. 1950-1, 12~.1
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