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4507
Fprrp OepaRtnent Ot the Treasury - Mternal Revenue Service
;R~, September,9Tt), Notice of Federal Tax Lien Under Internal Revenue Laws
District Sevin! Number For OpNOna/ Use DY Racadinp Office
~:-w-fly: , y=::. X373 ~l~'v 19 P4; 3~ 33
As provided by sections 6321. 6322, and 6323 of the Iniemal Revenue Code, r!LEO ,?N[ k= Cu~:UE t;
notice is given that taxes (including interest and penalties) have been assessed SLluc!Ecru~TY.fia.
ROGER POITRAS
against the fdlowing-named ta~cpayer, pemand for payment of this liability has CIEP.K C!RCU!T c~<«, i
been made. but it remains unpaid. Therefore. there is a lien in favor of the United ~;:rr,~p ~.-p,; (rn p ~ ~ _
States on all property and rights to property belonging to this taxpayer for the
amount of these taxes, and additional penalties, Interest, and Costs that may 4~i5O~
accrue.
Name of Taxpayer
~ n
Residence
Unpaid Balance
Kind of Tax Tax Period Ended Date of As>?easrnent Identifying Number of Assessrt)ent
/U (D) [c) (d)
, - ~ r:
- ? • 154•
~ / , R .
,
-33 •
Place of Fling
_ _
y y YW = fl r1
This notice was prepared and signed at • = c Fl.
on this,
the day of -c = - ,19
Signature Title (1r~te p AA
8(~X ~I~.lf P~GF 17~J
i Cert y onice? tauthor+rnd !aw to take icknOwieDpmt+nts is not vsssntia/ to the valid%ty W Notice d
FeWrd Tau Lien .Y.2ti~ip, Ipso-1, 25.)
- Part t "
,To be kept by recording office) Form 668 (Rev. 9-78)