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. Depertment 01 the Treasury . Internal Revenue serv~c~_c:
IForm 666 (V) (c) -;., t ". F ~ l.t ILE
(Rev. October t 993) Notice of federal Tax Lien
1- For Opl/onel Use by Recording Olllce
: OlsI/lHr':; vI. ','fJ' 1'\ Serial Number ,,:':-jd" I
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i As provided by sections 6321, 6322, and 6323 of the Internal Revenue Q7-4-3LP FTL
I Code, we are giving e notice that taxes (Including Interest and penalties) r'" .:J -,
\ have been aseessed egelnst the followlng.named taxpayer, We have made , --I 'll
a demsnd for payment of this liability, but It remains unpaid, Therefore, 'T' I
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there Is a lien In favor of the United States on all property and rights to ~ )~
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property belonging to this taxpayer for the amount of these taxes, and ".,) I.n
i ( ...-J .0
additional penalties, Interest, and costs that may accrue, I' "0
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I Name of Taxpayer -" j:!J
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\ Residence - 1:.:J ..D
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:!\RLISLE, r-n 1 '71\ 1. '~'
IMPORTANT RELEASE INFORMATION: For each assessment listed below, 1lC),00 pd
I unless notice 01 lien Is reflled by the date given in column (e), this notice shall,
I on the ~~iir"OWing such date, operate as a certificate of release as defined c..u.d 133<103
In IRC 6 (<lInT on::>' TO' ,"';;: 'C\ I Dee", " r, 1,1,";'-" . H f-J! 1.\11Q'),
! Tax Period Date of Last Day lor Unpaid Balance
Kind olTax Ended Identifying Number Assessme'lt Rellllng of Assessment
(a) (b) (e) (d) (e) (I)
~l_i.:l(' 1.213 , ,:;.. ::'ll-2,~- ;~-"-'= )~/2J' 81 .! ' !~. 171)21.3t)
1')4(' 12/3J.r; i :;~..1-'~~~--1.)::'7:~ (:2 i:::".::.. fJl ll:.'t... 1('973.73
Lt.'4(' .l2' 3117C :; ,ll--2 2-C272 l~<: 1:1'3 /2i II! P. g,-l0S.46
1')'~(' 12/ =il:'-i'; '21.1-~.:~. (~.": ('~'.I,y.:..' ~~ :'!/ -'; 72L'O.25
-- --.-. -- -....-- ..- --.-' - ..- -.- -.. .-.-,.- -, ... -. -,- -.- -.-- . . - --.- ,_.,- -.. -..------.-....- ----.-.-. --. .-.---.--- --- ._---
'HJ'- II:E [.i-=- ;:;~[,E? '\'- "-?'. II. L.J [,I FE> lL;"I:, .
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, ';e:" i ;) 1 1[' , --,'" ell )l.:t I'.:~ ";'. : C I? F- 1 I ~,j PIt: 1.U tlt'.~:' 1 ::..n j i, Jun y ,
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Place of Fliliig' . " _'._~. _' 'Ii ., , - . - .. -. ..
":". J l: r.,~! I' It. .', '. Total $
..: ..!rll\: t} f' 1 :' IIi (OL..1nll c:,:7l(1.7.;
(2.:'''-1 i~, 1 ~ . ':' r 1 ~-- ":J .1 ,
This notice was prepared and signed at
\ I"'.'
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, on this,
" -; ~
the ,':. :. 'day of
r ('! r :,_-7\ \ 19 G i
, -'
Signature
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'1 d
Title
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(NOTE: Cerlllle.'. 01 ollle.r .ulhorlz.d by I.w 10 lak. .eknowl.dgm.nlS I. nol ....nll.llo th. v.lldlly 01 Nolle. of F.d".' T.. lI.n
Rev. Rul. 71.466, 1971.2 c,e, 409)
Part 1 . Kept By Recording Office
Form 668 (V) (c) (Rev, 10/93)
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Fonn 668 (Z)
(Rev. 8.971
214
Department 01 the Treasury - Internal Revenue Service
Certificate of Release of Federal Tax Lien
District
Serial Number
For Use b Recordln Ollice
PENNSYLVANIA
239718014
I certilv that as te the lollowing.named taxpayer, the requirements of section 6325 (e)
of the Internal Revenue Code have been satislied lor the taxes listed below and for
all statutory additions. Therefore, the lien provided by Coda section 6321 lor these
taxes and additions has been released. The proper officer in the office where the
notice 01 internal revenue tax lian was liled on January 27
1997 ,is in authorized to note the books to show the release of this lien for
these taxes end additions.
Name 01 Taxpayer BRUCE I ROTZ
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~'" 'of? 4-rn
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Residence
P. O. BOX 194
NEW KINGSTOWN, PA 17072
$5,Cl:,)pd
c u..:tI \51l:;.~1
K-l:! q 2q38
Liber
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COURT
UCC No.
n a
RECORDING INFORMATION:
Serial No.
97-436 FTL
Page
n a
KInd of Tax
(s)
1040
1040
1040
1040
*******
Tax Period
Ending
(b)
12/31/1976
12/31/1977
12/31/1978
12/31/1979
**********
Identifying Number
(e)
211-22-6272
211-22-6272
211-22-6272
211-22-6272
*************
Date of
Assessment
(d)
02/23/1981
02/23/1981
02/09/1981
02/09/1981
**********
L.ut Day for
Reflllng
(e)
N/A
N/A
N/A
N/A
************
Unpaid Balance
of Assessment
(f)
17021. 30
10973,73
8495.46
7220.25
****************
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $
43710.74
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the
07th dey 01 March
2000
Signature
Title
(}adl?~ a LJ.:.J...r.....
CHIEF, SPB
(NOTE: Cortificate of officer authorizod by law 10 take acknowledgmonts is not essential to tho validity of Cortificate of Release of
Federal Tax lien Rev, Ru!. 71.466,1971 - 2 C,8, 4091
PIn I . RECORDING OFFICE
Foom 668 (Z) IRev. 8.971
CAT, NO 600261