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Form 668 (Y) (c) Department of the Treasury - Internal Revenue Service
(Rev. August 1997) Notice of Federal Tax Lien
District Serial Number For Optional Use by RecOrding Office
Small Business/ 230300802
Self-employed Area 3 03-~~Ffl-
As provided by sections 6321, 6322, and 6323 of the Internal Revenue Code, we are giving a notice that taxes (including interest and penalties)
have been assessed against the following-named taxpayer. We have made
a demand for payment of this liability, but it remains unpaid. Therefore,
there is a lien in favor of the United States on all property and rights to C> 0
property belonging to this taxpayer for the amount of these taxes, and 0
c W -n
additional penalties, interest, and costs that may accrue. ~:. '-
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Name of Taxpayer fl11i'!
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Harry S. & Maybelle Clavoool -< *(
Residence ~::: '-- -':J ,.-,~?-:c..;
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1937 Monterey Drive j;~ ::? ~J
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Mechanicsburq, PA 17055 .- ;/ ;>
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, -~ r'-'
unless notice of lien is refiled by the date given in column (e), this notice shall,
on the day following such date, operate as a certificate of release as defined in
IRC 6325(a). JtI.~ p::I.. /2:i +e' I ]i.IOt,' /
Kind ofTax Tax PerIod Ended IdentIfyIng Number Date of Last Day for Unpaid Balance of
(a) (b) (c) Assessment ReflJ/ng Assessment
(d) (e) (f)
1040 12/31/1999 190-16-2687 8/14/2000 9/13/2010 $ 37,531. 82
1040 12/31/2000 [90-16-2687 10/01/2001 10/31/2011 24,394.63
1040 12/31/2001 ",90-16-2687 5/27/2002 6/26/2012 26,416.62
Place of Filing PROTHONOTARY
CUMBERLAND COUNTY Total $
CARLISLE, PA 17013
RR 34'1.07
This notice was prepared and signed at HARRISBURG, PA
, on this,
the 28th day of JANTlARY
/003
Signature
Title
Revenue Officer
rized by law to take acknowiedgments is not essential to the validity of Nolice of Federai Tax lien Rev. Rul. 71-466, 1971-2 C.B. 409)
PART 1 a KePT BY ReCORDING OFFICE
Form 668 M eel (Rev. 8-97)
CAT. NO 60025X
I
499 Department of the Treasury - Internal Revenue Service
Fonn 668 (Z) Certificate of Release of Federal Tax Lien
(Rev. 10-2000)
Area: Serial Number For Use bv Recordina Office
SMALL BUSINESS/SELF EMPLOYED AREA #3 -h. hI! o:.;:w
Lien Unit Phone: (412) 395-5265 230300802
I eertify that the following-named taxpayer, under the requirements of seetion 6325 (a) ck-'II{
of the Internal Revenue Code has satisfied the taxes listed below and all statutory Ru-. })59f{
additions. Therefore, the lien provided by Code section 6321 for these taxa,s and
additions has been released. The proper officer in the office where the notice of
internal revenue tax lien was filed on January 28
2003 . is authorized to note the books to show the release of this Him for
these taxes and additions. 0 0 C)
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Name of Taxpayer .,', ~ I
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HARRY S & MAYBELLE CLAYPOOL -
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MONTEREY DR -- ;:.>
Residence 1937 .' 2< -
MECHANICSBURG, PA 17055-0000 '.--. 9
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COURT RECORDING INFORMATION: c.n
Liber Page UCC No. Serial No.
n/a n/a n/a 03-423
Tax Period Dace of Last Da.r. for Unpaid Balance
KInd of Tax Ending Identifying Number Assessment Ref! ng of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/1999 190-16-2687 08/14/2000 09/13/2010 37531.82
1040 12/31/2000 190-16-2687 10/01/2001 10/31/2011 24394.63
1040 12/31/2001 190-16-2687 OS/27/2002 06/26/2012 26416.62
******* **********'11 ************* **********<1 ,rr*********** ****************
Place of Filing Prothonotary
Cumberland County Total $ 88343.07
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the
07th day of March
2003
SignaturaL~'5./~,; I Title ~~~~~~~nce Technical Support
(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Release of
Federal Tax lien Rev. Ru!' 71-466,1971 - 2 C.B. 409)
Part f _ RECORDING OffICE Form 668 (Z) (Rev. 10-2000)
CAT. NO 600261