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Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
(Rev. October 2000)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #3 11 ()/- if!)? FTL
Lien Unit Phone: (412) 395-5265 230169359
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 C) 0 0
property belonging to this taxpayer for the amount of these taxes, and C - .,.,
additional penalties, interest, and costs that may accrue. s:: ~ .~
;:?]OJ "'" :-c -n
Name of Taxpayer CHARLES W, WILEY JR. D/B/A WILEY'S DEL z::::3 z rn'F
zC N ;39
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Residence >'0 :::: 0:0
200 MOUNTAIN RD ;So "~o
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LEWISBERRY, PA 17339 Pc '2
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IMPORTANT RELEASE INFORMATION: For each assessment listed below,
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 ~irt /::/1 ::;j5~ (?#76&i
in IRe 6325\a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilmg of Assessment
(a) (b) (c) (d) (e) (f)
940 12/31/1996 25-1354732 03/10/1997 04/09/2007 802,95
940 12/31/1997 25-1354732 03/16/1998 04/15/2008 594,14
Place of Filing
Prothonotary Total $
Cumberland County 1397.09
Carlisle, PA 17013
Q5T
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the
08th day of January
2001
SignatLlre /)., . ~~~enue Officer 23-01-1844
for c. ~ a lJ..' (717) 291-1995 x137
(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 G.B. 4091 Form 668(Y)(c) IRev. 10.001
Part 1 - Kept By Recording Office CAT. NO 60025X