Notice Of Lien

(a) Notices of lien filed to obtain a stay of collection pursuant to T.C.A. § 67-1-1801(c)(I)(C) must include either all of the taxpayer's property both real and personal, wherever situated, or unencumbered property of the taxpayer located in this state equal in value TAXPAYER REMEDIES FOR DISPUTED TAXES CHAPTER 1320-01-02 to at least one hundred fifty percent (150%) of the amount of the assessment or the portion thereof challenged by the suit. A notice of lien must be filed with the register of deeds of the county of the taxpayer's domicile or principal place of business in this state, the register of deeds of the county where the property is located, and the office of the Secretary of State. (b) The notice of lien filed with the register of deeds shall be in a form as follows, containing the following terms and conditions: NOTICE OF STATE TAX LIEN Pursuant to the provisions of T.C.A. § 67-1-1801, a lien exists in favor of the State of Tennessee upon the following property (check one): [ ] All property wherever situated, both real and personal, and rights, title and interest in property acquired either prior to or subsequent to the filing of this notice, belonging to the hereinafter named taxpayer. [ ] Property located in Tennessee, otherwise unencumbered, and having a value equal to at least one hundred fifty percent (150%) of the amount of the assessment (including any penalty and interest) challenged in a lawsuit filed or to be filed by the taxpayer pursuant to the provisions of T.C.A. § 67-1-1801. This property is described as follows: (description of property, value and exact location) This lien is given for the purpose of obtaining a stay of collection of tax assessment (including penalty and interest) challenged by the taxpayer in a lawsuit filed or to be filed by the taxpayer pursuant to the provisions of T.C.A. § 67-1-1801. This lien secures the payment of ______________________(amount of assessment, penalty and interest challenged in lawsuit) ___________($_____________) plus subsequently accrued interest. The current amount of this lien may be obtained by inquiry of the Tax Enforcement Division of the Tennessee Department of Revenue. ____________________________________________________________________________________ ____________________________________________________________________________________ Name of Taxpayer Account Number: Account Number: Residence or Place of Business: County: ____________________________________________________________________________________ Witness my hand at ______________________, Tennessee, on the______ day of ______________, __________. Taxpayer __________________________________ By________________________________________ TAXPAYER REMEDIES FOR DISPUTED TAXES CHAPTER 1320-01-02 ____________________________________________________________________________________ * FOR REGISTER USE ONLY -PRINT OR STAMP * ____________________________________________________________________________________ BOOK NO. PAGE NO. DATE TIME REGISTER BY:_______________________________________ ___________________________________________ RV-1307 (REV.5-85) 02-018-0503 (c) A notice of lien must also be filed with the office of the Secretary of State. Notices of Lien field in the office of the Secretary of State shall be filed in quadruplicate, on 5" x 8" blue paper, in a form as follows, containing the following terms and conditions: TAXPAYER'S VOLUNTARY GRANT OF LIEN TO DEPARTMENT OF REVENUE ____________________________________________________________________________________ _ Taxpayer's Name and Lienholder: Date, Time, Number Business Address: and Filing Office: ____________________________________________________________________________________ Tennessee Department of Revenue 1200 Andrew Jackson Office Bldg. Nashville, TN 37242 ________________________________________________________ TAXPAYER ACCOUNT NO.________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Description of Property Under Lien: See attached (attach copy of notice of lien filed with register of deeds, including attachments thereto) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________ ____________________________ Taxpayer's Signature Date (d) If the taxpayer owns property, either real or personal in other states, a notice of lien must be filed in these states, in the office designated for the filing of liens on property in the county in which the property is located and in the office of the Secretary of State of the foreign state. Such notices shall contain the terms and conditions as provided in subparagraphs (b) and (c) and shall be in the same form to the extent possible to file a valid lien in that state. TAXPAYER REMEDIES FOR DISPUTED TAXES CHAPTER 1320-01-02