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Form 668 (V) (c) 4('j~.) Depa,tment of the Treasury. Internal Rovonuo Sorvlce
(Rev, Oclober 1993) Notice of Federal Tax Lien
District Serial Number For Optlonsl Uu by Roca'dlnQ Olllcs
PE'NN:;YL VAN I A ?'4Q,/'Y:>C" c tto,
As provided by sections 6321, 6322, and 6323 of the Internal Revenue q'7-~C01? F1L
Code, we are giving a notice that taxes (Including Interest end penalties)
have been assessed against the followlng.named taxpayer, We have made
a demand for payment of this liability, but It remains unpaid, Thorefore, (' .:J ....,
thero Is a lien In favor of the United States on all property and rights to , -' on
property belonging to this taxpayer for the amount of these taxes, and , ~ "
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additional penalties, Interest, and costs that may aecrue, ~, .' .. ',-
, - 'i'
Name of Taxpayer ( .....J ,~
RICHARD D CASSEL ,
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Residence ;'.) "'
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27 E MAIN APT A !
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MECHANICSBURG. PA 17055-3852 .. .~ ..;
IMPORTANT RELEASE INFORMATION: For each assessment listed below, .$q,CX)pd
unless nollce of lien Is Ie filed by the date given In column (e), this notice shall,
on tho day following such date, operate as a certificate of release as defined CI.l!\ I<.'loq
In IRe 6325(a), P- 1\ 51 C)"l,( ^
Tax Period Date at Last Day for UnpaId Balanc.
Kind of Tax Ended Identifying Number Assessment Reflllng of Assessmont
(a) (b) (e) (d) (0) (f)
1040 12/31/95 204-26-8194 OS/27/96 06/26/06 1252.41
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~Place of Filing
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, Po'othonotary Total $
Cumberland COUrtty 1252.41
Carl isle PA 17013
,This notice was prepared and signed at Pil't.hll""h PA
:
, on this,
the 28th day of M'H'ch
,19-32.
Signature h"f.~-, }IZ e....,.,.."" '. Title
~W oI"ao ---.... v .~'l ...
for PATRI IA BETLEJEWSKI-AC~
MANAGER 23-01-0000
(NOTE: CerllUcate of ofllcer authorized by law 10 lake acknowledgments Is nol essontlal to lho ..,Qlidily 01 Nolle. or Foderal Tax lien
Aov, Aul. 71.466, 1971 .20,0.409)
Part 1 . Kept By Recording Office
Form 668 (Y) (c) (Rev. 10/9'
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