HomeMy WebLinkAbout01-2067 FX
499
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 #(){ -:20&7 FTL
Lien Unit Phone: (800) 829-3903 230173024
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 0 c:' ~~?
a demand for payment of this liability, but it remains unpaid. Therefore, c: ..- ,(
there is a lien in favor of the United States on all property and rights to ~.s: :l::'::"
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property belonging to this taxpayer for the amount of these taxes, and rnt\-~ :::'J
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additional penalties, interest, and costs that may accrue. zr:- I
(f)...,: 'D
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Name of Taxpayer SANDY S OLSEN ~c~ -v
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PC: .. ......~;
Residence Z '"" ~
34 BALI HAl RD APT 34A =1
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MECHANICSBURG, PA 17055-1902 ~,
IMPORTANT RELEASE INFORMATION: For each assessment listed below, CK;tJ:/1 \
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 ~# loC, 991
in .IRe 6325(a),
, .' Tax Period Date of Last DalY. for Unpaid B,alance
Kind of Tax Ending Identifying Number Assessment Refi 109 of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/1993 208-38-5062 05/30/1994 06/29/2004 3987.57
1040 12/31/1994 208-38-5062 OS/29/1995 06/28/2005 4483.40
1040 12/31/1995 208-38-5062 OS/20/1996 06/19/2006 1690.29
.1040 12/31/1996 208-38-5062 OS/26/1997 06/25/2007 1068.06
1040 12/31/1998 208-38-5062 05/31/1999 06/30/2009 2171. 03
1040 12/31/1999 208-38-5062 06/05/2000 07/05/2010 2361.48
Place of Filing
Prothonotary Total $
Cumberland County 15761.83
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
28th day of March
2001
the
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!. 71A66, 1971 - 2 C,B, 4091
Part I - Kept By R d' om Form 668(Y)(c) (Rev, 10,001
ecor 109 Ice CAT. NO 60025X
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