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Form 668 'I OepaAment of ihe Treasury - Internal Revenue Service
(Rev.September1978)I Notice of Federal Tax Lien Under Internal Revenue Laws
~IS~fIC~ Seriai Number Fo~ Opfwnal Use by Recwdiny Ollice
519449 ~uR -6 '
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As provided by sections 6321, 6322, and 6323 of the Internal Revenue Code, ~Kfp EIJt FECOkDf 0
S~_~~K CptttltY•f-i--
itGGER POITRAS /~
notice is given that taxes (including interest and penalties) have been assessed CL~K C~CUIt CO y'
against the following-named taxpayer. Demand for payment of this liability has ~
been made, but it remains unpaid. Therefore, there is a lien in favor of the United u : r.c;~'~ ~'~Rt~ :` ^-- C
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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
accrue. 519449
Name of Taxpayer
~~li k ~rr~ Lll+q
Residence
57~L7 S.M. vhi~a i~snn~s
r.~ cs~,, n.~. s~
. u~pafa ea~ance
Kind of Tax Tax Period Ended Date of Assessment Identifyiny Number of Assessment
fs) fb) fc) fd) (s)
l~ 3~ ?~12 ~~ l~-34~3n u7~11~.02
Place of Filing ~~ ~ ~ ~~i~ ~
~• ~'~ ~0~~ Total i 11T~11~6~02
!'t. Pi~rss, tla. 3345~
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~ This notice was prepared and signed at Yeat~als leLh~ ll,. , on this.
the_~_ day of ~ ,19 ~
Signature Title
a. v. Cart~s C.~. l, ad.~s... om~.s
,
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~ (Not~: Certificate o! ofl~cer ~ufhoiized Oy law to ake ackno+rlWpmonts !s not oss~ntia/ fo th~ v~fdity o/ Notlc~ o!
FeWr~l Tur Uen (i.C.M. 26~1~. 1~541. C.B. 1?b.) (~R
eornc PacE 197
~ Pan 1- To be kept by recordin~ oHfce , Form 668 (Rev. 9-78)
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