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HomeMy WebLinkAbout2965 ~ i • i Form 668 DEPARit~ENT Of THE iREJISURY-INTERNAL REvQ~{UE SER1fICE - forOptJona/ Use By Rernrding Ohlice } ; _ ~aEV.2.~~) NOTICE OF FEDERAL TAX LIEN UNDER IMTERNAL REYEMdE LAWS - ` DISTRICT J~~r~~ _ SERIAL NUMBER - L,-~.st+;~ ~,F.qtiF t - tU~~~~ ~%4~., ~,TY~ ' ''U''~~S' . _ Pursuant tothep~ovisionsofSeciions6321,6322,and 6323 of the Internal Revenue ~~-~~f~ C4{!R~ Code; notice is hereby given thot there have been assessed under tke Internal Reve- ' i"' ' nua laws of Ihe United Sloies~against the foliowing-named taxpayer~ toxes (including , - interes~ ond penalties) which ofter demand for p,:y~-+ent thereof remaTn unpatd, ond ~y ~~7` - thoi by virtue oftheabove-mentionedstatutestheomovnt of said taxes, togeiher wlth penafties, interest, and costs that mayaccrueinaddition the~eto, Ts a Ilen in favor oi - the United Statesuponollpropertyandrightsto proparty belongTng to satd taxpayer. ~ NAME OF TAXPAYER , . - ; . ~ ~ Ja¦ri R~ G~e'ts't~ M I.o~ritt ~ . - RESIDENCE ~M~ ~ _ . - - 5- - ~ F't p~~lO~ e ~3. 33~50 = . , = ~ " UNPAID BAIANCE ~ KINO OF TAX TAX PERIOD ENDED DATE OF ASSESSMENT IDENTIFYING NUMBER OF ASSESSMENT (a) (b) . (c) - ~d~ ~ei - - ~ , ~-3L-73 06-~3-7~+? ~5-32-~66? ?78.2? ~ r~ - - . ; . ~ " ~ PLACE OF FIUNG ~ - - C1~k, C~t'Orit OO~t - ~ . . _ . ~ ~ ~ $t L1~01+~ Oo'1~A~? _ - tOTAI $ ~g,~ i - ~ ~'O~~ ~~t~ . ~ - - ~ - ~ . ~ _ _ _ t - WITNfSS my hand at ~1~3'~ _ ort thTs, ~ _ . : _ - • l _ _ tha~_doy_af- , 19 7~4 - . - _ - , - - . : _ ; - SIGNATURE TITLE - ' - ~ - - O~t~ E?lt'io~ $~pk . - - = _ _ _ - s (NOTE; C~rtiFlcot~ of offk~r outhorqed by low to lak~ otknowl~dym~nl~ Is not •ti~ntlal lo IA• voliditr of No1iu ,qf F~d~roi Tox li~n G.CJV1. 2G419. C.B. 1450-51, 125.) : - - ~ = . ~ PART 1-To b• nfain~d by c~cording offic~ ~~OK~VV ~+~~~~ity~7 - ~ ~ " - -