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Fol'll1 668 (Y)(c) Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
(Rev, October 20001
Area: Serial Number For Optional Use by Recording Office
SMALL BUSINESS/SELF EMPLOYED AREA #3 #01- 303~ Fit.-.
Lien Unit Phone: (SOO) S29-3903 230174976
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, C) 0 C)
there is a lien in favor of the United States on all property and rights to c -,-
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property belonging to this taxpayer for the amount of these taxes, and ~Jr::.' :It
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additional penalties, interest, and costs that may accrue. ?~x,,' -< 'T"
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Name of Taxpayer DONALD R CLITES ~~j CD
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Residence YORK Z ..
615 W OLD RD -"1 " 5;1
CARLISLE, PA 17013-9155 -<c .- ::0
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, CK*/~q
unless notice 01 the lien Is rellled by the date given In column Ie). this notice shall,
on the day following such date, operate as a certificate of release as defined '-'kit'IOSJ-
in IRe 6325(a).
Tax Period Date of Last DaK. for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Ref! mg of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/1991 167-40-1663 OS/29/1995 06/28/2005 2139.38
1040 12/31/1992 167-40-1663 04/10/1995 05/10/2005 307.70
1040 12/31/1993 167-40-1663 04/17/1995 05/17/2005 3003.25
Place of Filing
Prothonotary Total $
Cumberland County 5450.33
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the
08th day of May
2001
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,S, 409) Form 668(Y)(c> IRev, 10,OO}
Part 1 - Kept By Recording Office CAT, NO 60025X
Title
ACS
23-01-0008
Signature
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