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3355
Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c)
Notice of Federal Tax Lien
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(Rev. February 2004)
Area: Serial Number
WAGE & INVESTMENT AREA #1
Lien Unit Phone: (800) 829-7650 349155207
A5 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 bf Taxpayer JAMES A PERAGINE
For Optional Use by Recording Office
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Residence
16 EASTGATE DR
CAMP HILL, PA 17011-1309
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is retiled 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 IRe 6325(a).
Kind of Tax
(a)
1040
Tax Period
Ending
(b)
12/31/2003
Identifying Number
(c)
XXX-XX-1036
Date of
A5sessment
(d)
04/03/2006
Last Day for
Refiling
(e)
05/03/2016
Unpaid Balance
of A5sessment
(0
11340.93
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $
11340.93
This notice was prepared and signed at
DETROIT, MI
, on this,
06 th day of March
2007
the
Signature
Title
ACS
(800) 829-7650
11-00-0000
for DEBRA K. HURST
(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. 2-2004)
CAT. NO 60025X