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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(c) Notice of Federal Tax Lien
(Rev. October 2000)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #3 / c,q a F7L
Lien Unit Phone: (800) 829-3903 230171921 0/-
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are giving a notice that taxes (including interest and penalties) (") 0 ()
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have been assessed against the following-named taxpayer. We have made g ::J:: --I
a demand for payment of this liability, but it remains unpaid. Therefore, "00:0 :,:;.. ~1= '"1:J
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there is a lien in favor of the United States on all property and rights to Z..~ ..-
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property belonging to this taxpayer for the amount of these taxes, and N .;:;-;
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additional penalties, interest, and costs that may accrue. '<C' Cl ... -,.
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Name of Taxpayer DAVID WILEY )>0 -
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Residence 115 HIGH MT RD
SHIPPENSBURG, PA 17257..9655 Ftc P~~1J q 67J
IMPORTANT R[L[AS[ INFORMATION: For each assessment listed below, U 1ft 2..DOY-
unless notice of the lien is refiled by the date given in column fe), this notice shall,
on the day following such date, operate as a certificate of release as defined (fJ/ /&1 }to
in IRe 6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax [nding Identifying Number Assessment , Refihng of Assessment '
(a) (b) (c) (d) (e) (f)
1010 12/31/1996 166-54-2327 06/02/1997 07/02/2007 255.68
1010 12/31/1997 166-54-2327 05/18/1998 06/17/2008 828.05
1040 12/31/1998 166-54-2327 06/04/1999 07/04/2009
1040 12/31/1998 166-54-2327 07/05/1999 08/04/2009 6591.37
1010 12/31/1999 166-54-2327 06/15/2000 07/15/2010 2644.35
Place of Filing
Prothonotary Total $
Cumberland County 10319.45
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
07th day of March
2001
the
Signature
a l.)_:J_~ J:~~
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. Rul. 71-466, 1971 - 2 C.8. 4091
23-01-0008
Part 1 - Kept By Recording Office
Form 668(Y)(c) IRev.. 10-001
CAT. NO 60025X
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