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Form 668 (Y)(c)
(Rev. October 2000)
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (412) 395-5265 230174473
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 liabiliW', but it remains unpaid. Therefore,
there is a lien in favor of the United States on all properW' and rights to
properW' belonging to this taltpayer for the amount of these taxes, and
additional penalties, interest, and costs that may accrue.
Name of Taxpayer TIMOTHY M BLOSSER , a Partnership
For Optional Use by Recording Office
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Residence
1669 QUAIL DR
CARLISLE, PA 17013-1245
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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
in IRe 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) (f)
940 12/31/1995 25-1752016 06/10/1996 07/10/2006 140.63
940 12/31/1996 25-1752016 08/25/1997 09/24/2007 2556.28
941 06/30/1995 25-1752016 03/04/1996 04/03/2006 208.02
941 09/30/1995 25-1752016 02/19/1996 03/21/2006 826.10
941 12/31/1995 25-1752016 04/01/1996 05/01/2006 788.38
941 03/31/1996 25-1752016 06/17/1996 07/17/2006 1968.83
941 06/30/1996 25-1752016 09/16/1996 10/16/2006 4493.00
941 09/30/1996 25-1752016 09/15/1997 10/15/2007 1720.23
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $
12701.47
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
27th day of April
2001
the
Signature
,~J I a Title
..' CVlI'~ Revenue Officer
for D. FISHER (717) 221-3490
(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) Form 668(Y)(c) (Rev. 10-001
Part 1 - Kept By Recording Office CAT. NO 60025X
23-01-1439
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2554 Department of the Treasury - Internal Revenue Service
Form 10916(c) Withdrawal of Filed Notice of Federal Tax Lien
(Rev. 10-2000)
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #3 ~,Idfi B..tf.()()
lien Unit Phone: (412) :595-5265 230174473
I certify that the following-named taxpayer has met one or more of the elements ck 9'1'1
of the Internal Revenue Code (IRq section 6J23(j). The Internal Revenue Service
therefore withdraws the Notice of Federal Tax Lien for these taxes and additions. f!u., . J'f f 1b')..
The withdrawal of this notice of lien does not affect the statutory lien provided
by IRC section 6321; it simply relinquishes any lien priority obtained by the Internal
. Revenue Service when the notice was filed. The proper official, in the office where
the Notice of Federal Tax Lien was filed on May 07 , 2001 . , 0 '"
is authorized to update the records to show the withdrawal of the notice of lien = 0
C:. =
for these taxes and additions. ~J}i~ ~ .,
Name of Taxpayer TIMOTHY M BLOSSER, Partnership :!: .-/
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Residence 1669 QUAIL DR ~Cj Q6
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CARLISLE, PA 17013-1245 -",'- 0--
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COURT RECORDING INFORMATION: .c- -<;
Liber Page UCC No. Serial No.
n/a n/a n/a 01-2747 FTL I
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refihng of Assessment
(a) (b) (c) (d) (e) (f)
940 12/31/1995 25-1752016 06/10/1996 07/10/2006 140.63
940 12/31/1996 25-1752016 08/25/1997 09/24/2007 2556.28
941 06/30/1995 25-1752016 03/04/1996 04/03/2006 208.02
941 09/30/1995 25-1752016 02/19/1996 03/21/2006 826.10
941 12/31/1995 25-1752016 04/01/1996 05/01/2006 788.38
941 03/31/1996 25-1752016 06/17/1996 07/17/2006 1968.83
941 06/30/1996 25-1752016 09/16/1996 10/16/2006 4493.00
941 09/30/1996 25-1752016 09/1:5/1997 10/15/2007 1720.23
*****-;.:* ~.-* * * * * * * * * * oJ ************* **********~ ************ ****************
Place of Filing
Prothonotary
Cumberland County Total $ 12701.47
Carlisle, PA 17013
This notice was prepared and signed at
Philadelphia, PA
, on this,
the 08th day of March
2004
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Title Compliance Technical Support
Manager
Cat. No. 24586T
Part 1 - Recording Office
Form 1 0916(c) (Rev. 10-2000)