HomeMy WebLinkAbout5228 `
Form 568 DEP/utTMENT Of TME T1fASUQY-NiEiNAt REVENt1E SEIMCE Fa Oprionoi Use 8y Rec«d~ng OfRce
l~- NOTICE OF fEOERAI TAX l~l UNDBt WTERNAL REVENI~ UVYS . q~U
61STRICT SERIAL NUMBER ~~R j4"
T.,C~,•.•~ ~`r ' ~ , : ~ ^,•~c; ~ CLERII ~,tf'?('.vtT COIIRT ~
Pursuant to the provisions of Sections 6321, 6322, and 6323 of the Interna{ Reve- ~RIi1f0 ,
nue Code, notice is hereby given thot there have be~n ossessed under the internal ~ a
Revenue lows of the l3n~ted Ssates against the following-named taxpoyer, taxes (includ-
ing ;nterest ond pennlties) which ahet demand for payment thereof remoin unpaid. and
that by virtue of the abovementioned statutes ihe omount of said !oxes, together with
penolties, interest, ond costs that moy accrue in addition thereto, is a lien in favor of 245130
the United Stotes upon ali property and righh to propeily belonging fo said taxpayer.
NAME OF TAXPAYER h~ n-
• ,
,r;Y.-iP~ J^1^ _i"nx i~All'1C~r
RESIDENCE .~-„t~:l _ , S ~n~~,t
`r';_ ,
UNPAtD BAUWCE
~ KIND OF TAX TAX PERIOD ENDED ASSESSMENT DATE IUENTIFYING NUNISER OF ASSESSMENT
k (al (~1 k1 ldl (el
~
i ~.~,,-.~_ry~ ~,:_~~~,7~".; ~1`-~~•7~
i
f
e
I
~
~ .
~
~
R
~
~
~
~
~
~
~
PUCE OF FlUNG - ; r , • ~ ~ t, - -
~l^.. _ " _ _ " J
:~t, ' • , _ . TOTAL = ~
. y. ~r~a~ i: _~"'1 : : c ~
~i '
t
' _''f, ~i~^!~~, ~~OZr'.~'-,
WITIJESS my h~d a~ ' , on this,
~
~ 3 : . . _ - ~ ~z • ~ilt)X ~f4~,f ~
the ' doy of , 19
z~ ~G{Jq~E T1TLE
~ C / •~,'i ?.~i~°`~'.'.? l~~nfi~~r
/
~NOTE: Certificate of oifica avthorized by law to toke aclenowledgmenfs is not essentiol to the volid~ty of Nofice of F~ederol Tmc lien G.C.M.
Y6419, C.B. 1950-51, 125.)
~ PART 1-~o b..aa~d br o~~
_ ~
~ ~
y u
~.s"~ ~ ° ~ ~ ~ ~ ~ ~
~ . _ ~ _ ~~~~4