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, Form 669 (V) (c)
; (Rev. Augus11997)
I
I District
,
i PEI"IN~;'YLVL.\.f'lIP., :?3',;lfj.l..l:3!:,:'7
I As provided by sections 6321, 6322, and 6323 of the Internal Revenue
". Coda, 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,
phere Is a lien In favor of the United States on all property and rights to
property belonging to this taxpayer for the amount of these taxes, and
I additional penalties I Interest, and costs that may accrue,
I Name 01 Taxpayer l~rCHAEL. L HOL~.ERT
I
J Residence
Jfl"ll.l
Department 01 the Treaaury . Internal Revenue Service
Notice of Federal Tax Lien
Serial Number
For Optlonsl Us. by Recording omcs
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4902 CARLISLE PI31.t
1\1ECHANICSBURG. PA 1'?OES-3079
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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).
Kind 01 Tax Tax Period Ended Identifying Number
.~ ~) ~
Date 01
Assessment
(d)
$q.cofd
e>>-:t:i 14JI4Oo
l'Z cd u>'1~74
Last Day lor Unpaid Balance 01
Rellllng Assessment
(a) (f)
('~
(')
1
)
l
f
j
1040
1040
1040
1040
1040
12/31/199(\
12/3J.lJ.991
12l31/199~~
12/31/J993
12/31/1994
192-34-'5887
192-34-5887
192-34-5887
192-34~~~;887
1'92-84-5887
(l3/'3'~'/ 1998
01/27/1997
01/2?/193]
1')/03/1994
11/18/1996
04/2912(l()8
('2/.2:6/2007
02/26/21)1)7
11/02/2004
12/18/2006
18025.83
11315.4-6
13163.95
9371.07
13374.21
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I Place 01 Filing
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jThls notice was prepared and signed at
I
09thd f
I.the ay 0
,
I Signature
,I' i'm' I).
P"'-:lthonot~",}'
Cu.mber"'l and COI.!nty
Ca,''\isle, P,l\ J7013
Total
$
65250.52
Pit-t,sbut..'.:.lh~ P.t\
June
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I
lillo
Zt.'!UOZIN /JV 'L)'~ '
Vt<'...VLA.4.~_ ....;."-;./""""'-.,
:> (NOTE: Cortificato o( oflicor autho~/7.O(/ by law to taka "C:~lIolYltJ{l(}f/ItJ"l. in JI()/ tJtWtl/J1I1l1 /(llho 1'I11;iflly of No/lell j)f Feltlt'f;!l nr~ /1011 Rov. Rul. 71-466, 1971.2 ().B.1~,9)
1'1~,!\/l~nU(~ DI~f'l""~t~I' 23-01-1'+4-1
PAnr I . Ka.:I'f tlV nt(:nlllllt~11 OHIC~
FOfm 668 (Y) (e) (Rov. 8,97)'
CAT. NO ec025X