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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
(Rev. October 2000)
Area: I Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #3
lien Unit Phone: (412) 395-5265 105183303
As provided by section 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
property belonging to this taxpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Name of Taxpayer JEFFREY T DEHAVEN
Notice of Federal Tax Lien
Residence 24 WARWICK CIR
MECHANICSBURG, PA 17050
IMPORTANT RELEASE INFORIqATION: For each assessment listed below,
unless notice of the lien is refiled by the date g ven in column (e), this notice shall,
on the day following such date, operate as a certificate of release as defined
5(a). ~ ~
Tax Period Date of
Kind of Tax Ending Identifying Number Assessment
(a) (b) (c) (d)
1040 12/31/1992 190-58-8083 08/21/1995
Prothonotary
Cumberland County
Carlisle, PA 17013
Last Day for
Refihng
(e)
09/20/2005
3r Optional Use by Recording Office
Place of Filing
Total
C>
Unpaid Balance
of Assessment
(f)
9756.55
9756.55
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
12-00-0000
the 26th day of March 2003
for P S LANE (800) 829-7650
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Rul. 71-466, 1971 - 2 C.B. 409)
Part 1 - Kept By Recording Office Form 668(Y)(c) (Rev. 10-00)
CAT. NO 600~5X