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Form 668 Department of the Treasury -Internal Revenue Service
(Rev_Septemher1978) Notice of Federal Tax lien Under Internal Revenue Laws
District Serial Number 4~~~ For Optionat:f/ae M Racwding Ollics
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JAC}'.SGi,`~JILLL
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As provided by sections 6321. 6322, and 6323 of the Internal Revenue Code. st~~l,~
notice is given that taxes (including interest and penalties) have been assessed R T
against the following•named taxpayer. Demand for payment of this liability has 0.~~
been made, but it remains unpaid. Therefore. there is a lien in favor of the Unitec~E ?~ERIFlEO
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States on all property and rights to properly belonging to this taxpayer for the
amount of these taxes. and additional penalties. interest. and costs that may A 9Sr~~
accrue. •3
Name of Taxpayer
Residence
~i''LZ;Y $1 r~'Y art.'.. n-..
- Unpaid t3alartce
' Kind of Tax Tax Period Ended Owe of Assessment Iderttifttirq Number of Assessrnant
~ (a) (D) (c) (d) (e)
Ij ic~a 12-3i-79 0?-28-i3o 577-~-36zc 2r~94.97
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Place of Filing
CL~R}~ OF T}iE CI3CLZT CC~I;If•
ST LL'CI COI.ii~Y CCR7~~~iCL'S:: Total = 2, 694.9'j
a~'G~f1 PI~'RC::r r~ 33~+So
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This notice was prepared and signed at ~'HT PIr.nC~. r'LA . on this.
d
the ftr~ day of AliCtST ,19 ~0
Si u Title
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' hw ~.tli:iU~ GPICER
Casrlifiule o ollitsr avlhorized by Nw fo fake acknowlsdpmar•b is nor esaantial to tM validlfy o1 Notke o/
' F Ta: Lien .N. 26x19, 1950.1, C.B. 12b.)
Part 1 - To be kept by recwrdirq Form 668 (Rev. 8.78)
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