HomeMy WebLinkAbout2723 ---FOnn 668 DEP/WiMENT OF ilE TREASURY-WTERNAI REVENUE SERVICE For ionol Ust Ra~corddng OH~ict .
{REV. 1-7Q) NOTKE 0€ fEDERAI TAX LIEN UlIDNt NiiHtiAl REYENUE U1lVS ~
D~STRICT SERIAL NUMBER ~fR ~TM~
~OM~ ~ERIi~E! ~r
Pursuant to the provisions of Sections 6321, 6322, and 63~3 of the Internal Reve- y~
nue Code, r.olice is hereby give~ that there have beeo assessed under the Internal ~T L( i~~~ -
Revenue laws of the United Stotes agoinst the fdbwing-named taxpoyer, toxes (inciud- -
ing inte~est and penalties) which aher demand for pv~rment thereof remoin unpaid. and "
thot by virhie of the abov~mentioned statutes the amount of soid roxes, togethe~ with ~;,(Z~G~
penahies, interest, and cosh that may occrue in addition thereto, is o lien in fovor of ti~`r~~ ~
the United States upon all property and righh to property belo~ging to said taxpaycr.
NAME OF TAXPAYER
ZA~~N DMN
RESIDENCE
1Z01~ II, B~Z ~21T
1~~art Pi+~s~o~~ ~'l+orliL _
UNPAID BAtANCE
KIND OF TAX 7/V( PERIOD ENDED ASSE~SMENT DATE IDENTIFlfING NUMBER OF ASSESSMENT
l~l ro1 k! Idl (el
LOlaO 1Z-31~-G8 6-6-69 ~54-~6-~1~5 ~136.00
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~ v+nTNESS n+r hond or Ys~t Pala D~~i. !"lerlda , on M,~,
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~ the ~_day of OC~iYb~r , 19~ -
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SIGNATUR TiTIE -
~~~~N~~ Q ~~U! ~~rs~
~ (NOTE: Certificare of oR~c~r ovthoriud by law fo tak~ ocknowledgmenb a no~ ~ntial w 1ht vdidihr d Noiia of F~rd Tmc l'wn S's.C.M.
~ 26419, C.6. 1950-S1, 125.)
~ PART 1-To b~ ntain~d bp nco~din~ oAk~
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