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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
I Rev. October 2000)
Area: Serial Number For Optional Use by Recording Office
WAGE & INVESTMENT AREA #2 if 05-- ?0!:J7 FTL-
Lien Unit Phone: (800) 829-7650 230067908
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 0 0
property belonging to this taxpayer for the amount of these taxes, and (")
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additional penalties, interest, and costs that may accrue. .s:: :z .-,
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Name of Taxpayer JESS A MIDDLETON ~!:Jj <:
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Residence 62 MARILYN DR ~o ::t: '40
CARLISLE, PA 17013-8885 ;;;2 - elm
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice 01 the lien is reliled by the date given in column (e), this notice shall,
on the day following such date, operate as a certificate of release as defined (((# /64:Jp I
in IRe 6325(a).
Tax Period Date of Last Da.r. for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refi ng of Assessment
(a) (b) (c) (d) (e) (0
1040 12/31/1997 366-74-7851 10/18/1999 11/17/2009 13475.16
Place of Filing
Prothonotary Total $
Cumberland County 13475.16
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
I on this,
the
09th day 01 November
2000
Signature
~ a LJ~ I!~~
for LOIS DOWD (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. Ru!' 71-466, 1971 - 2 C.8. 4091 Form 668(Y)(c) (Rev. 10-001
Part 1 . Kept By Recording Office CAT. NO 60025X
23-01-0000