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Form 668 (Y){c) Department of the Treasury - Internal Revenue Service
Noti(e of Federal Tax Lien
(Rev. October 2000)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #3 tOI-/IG! AL
Lien Unit Phone: (800) 829-3903 230170782
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are gMng a notice that taxes (including interest and penalties) S2 ~..
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have been assessed against the following-named taxpayer. We have made ~ -
a demand for payment of this liability, but it remains unpaid. Therefore, ::..:.:::., ~1
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there is a lien in favor of the United States on all property and rights to mi";-' ',::':1
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property belonging to this taxpayer for the amOUD1t of these taxes, and 7'=._
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additional penalties, interest, and costs that may accrue. S%~:)
Name of Taxpayer ROMAYNE F PALMER --p
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Residence 148 AMY DR
CARLISLE, PA 17013-8884
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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, ~.f /01f ~C&
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax Period Date of Last Dad'; for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refilng of Assessment
(a) (b) (c) (d) (e) (I)
1040 12/31/1996 125-42-2367. 07/05/1999 08/04/2009 6276.48
1040 12/31/1998 125-42-2367 OS/24/1999 06/23/2009 737.27
Place of Filing
Prothonotary Total $
Cumberland County 7013.75
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the
13th day of february
2001
Signature
,.
Title
ACS
23-01-0008
for L G DOWD (800) 829-3903
(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 668(Y)(c) (Rev. 10-001
Part 1 . Kept,By Recording Office CAT. NO 60025X
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