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499 Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. August 1997)
District Serial Number For Optional Use by Recording Office
PENNSYLVANIA 230062693 ~CtJ - U 6'::>4 flL
As provided by section~63211 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties) ~ 0 0
have been assessed against the following-named taxpayer. We have made 0 ~"
a demand for payment of this liability, but it remains unpaid. Therefore, V> ~.... I
-O:OJ m ......
there is a lien in favor of the United States on all property and rights to ~'-gj -0 (t1~
property belonging to this taxpayer for the amount of these taxes, and ~~ ~- :':~io
additional penalties, interest, and costs that may accrue. (X) ~:.::>t'
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Name of Taxpayer KENNETfl G BURRY X ':>0
:3>8 "P. 2m
0
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en ~
Residence 401 PINE RD . '"
MT HOLLY SPGS, PA 17065-1824 ID9 CO
IMPORTANT RELEASE INFORMATION: For each assessment listed below, fJtlJ3J(Q(j
unless notice of the 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 ~ loll ql
in IRe 6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refihng of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/1993 332-56~6461 11/11/1996 12/11/2006 4371.19
1040 12/31/1998 332-56~6461 11/08/1999 12/08/2009 3601.58
Place of Filing
Prothonotary Total $
Cumberland County 7972.77
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the
31st d f' AUgust
ay 0
,/)
2000.;
Signature
for LOIS DOWD
Title
ACS 23~01-0008
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Ru!' 71-466, 1971 .2 c.B. 4091 Form 66B(Y)(c) (Rev. 8-97)
Part 1 - Kept By Recording Office CAT. NO 60025X