day of , .

Department of the Treasury - Internal Revenue Service

(Rev. January 2000) Revocation of Certificate of Release of Federal Tax Lien

Cat. No. 28891D

District Serial Number For Optional Use by Recording Office

Name of Taxpayer

Residence

Kind of Tax Identifying Number

(a) (b) (c) (d) (e) (f)

Place of Filing Total

$

This notice was prepared and signed at , on this,

the

Signature Title

Form 12474-A

Part 1 - Recording Office

Unpaid Balance

of Assessment

Tax Period

Ended

Date of

Assessment

Last Day for

Refilling

I certify that we mistakenly allowed a Notice of Federal Tax Lien filed against the

taxpayer named below to operate as a Certificate of Release. I declare that the

automatic release of the Notice of Federal Tax Lien is revoked and that the lien is

reinstated as provided under Internal Revenue Code Section 6325(f)(2).

(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Revocation of Certification of Release of Federal Tax Lien

Rev. Rul. 71-466, 1971-2 C.B. 409.)

Form 12474-A (Rev. 01-2000)
Federal Tax Lien released in error.

Failure to comply with collateral agreement in

connection with a compromise.

Liability was not discharged through litigation.

Notice of Federal Tax Lien was not refiled timely.

Reason For Revoking the Certificate of Release and

Reinstating the Notice of Federal Tax Lien

Form 12474-A (Rev. 01-2000) Page 2
day of , .

Department of the Treasury - Internal Revenue Service

(Rev. January 2000) Revocation of Certificate of Release of Federal Tax Lien

Cat. No. 28891D

District Serial Number For Optional Use by Recording Office

Name of Taxpayer

Residence

Kind of Tax Identifying Number

(a) (b) (c) (d) (e) (f)

Place of Filing Total

$

This notice was prepared and signed at , on this,

the

Signature Title

Form 12474-A

Part 2 - Taxpayer Copy

Unpaid Balance

of Assessment

Tax Period

Ended

Date of

Assessment

Last Day for

Refilling

(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Revocation of Certification of Release of Federal Tax Lien

Rev. Rul. 71-466, 1971-2 C.B. 409.)

Form 12474-A (Rev. 01-2000)

I certify that we mistakenly allowed a Notice of Federal Tax Lien filed against the

taxpayer named below to operate as a Certificate of Release. I declare that the

automatic release of the Notice of Federal Tax Lien is revoked and that the lien is

reinstated as provided under Internal Revenue Code Section 6325(f)(2).
Federal Tax Lien released in error.

Failure to comply with collateral agreement in

connection with a compromise.

Liability was not discharged through litigation.

Notice of Federal Tax Lien was not refiled timely.

Reason For Revoking the Certificate of Release and

Reinstating the Notice of Federal Tax Lien

Form 12474-A (Rev. 01-2000) Page 4
day of , .

Department of the Treasury - Internal Revenue Service

(Rev. January 2000) Revocation of Certificate of Release of Federal Tax Lien

Cat. No. 28891D

District Serial Number For Optional Use by Recording Office

Name of Taxpayer

Residence

Kind of Tax Identifying Number

(a) (b) (c) (d) (e) (f)

Place of Filing Total

$

This notice was prepared and signed at , on this,

the

Signature Title

Form 12474-A

Part 3 - IRS Copy

Unpaid Balance

of Assessment

Tax Period

Ended

Date of

Assessment

Last Day for

Refilling

(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Revocation of Certification of Release of Federal Tax Lien

Rev. Rul. 71-466, 1971-2 C.B. 409.)

Form 12474-A (Rev. 01-2000)

I certify that we mistakenly allowed a Notice of Federal Tax Lien filed against the

taxpayer named below to operate as a Certificate of Release. I declare that the

automatic release of the Notice of Federal Tax Lien is revoked and that the lien is

reinstated as provided under Internal Revenue Code Section 6325(f)(2).
Federal Tax Lien released in error.

Failure to comply with collateral agreement in

connection with a compromise.

Liability was not discharged through litigation.

Notice of Federal Tax Lien was not refiled timely.

Reason For Revoking the Certificate of Release and

Reinstating the Notice of Federal Tax Lien

Form 12474-A (Rev. 01-2000) Page 6

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