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499
Form 668 (Y)(c) Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien
(Rev. October 2000)
Area: Serial Number For Optional Use by Recording Office
WAGE & INVESTMENT AREA #2 tt(jI~37 dd
Lien Unit Phone: (800) 829-7650 230176247 reI
As provided by section 6321, 6322, and 6323 of the Internal Revenue
Code, we are gMng a notice that taxes (including interest and penalties)
have been assessed against the fOllowing-named taxpayer. We have made C)
a demand for payment of this liability, but it remains unpaid. Therefore, 0 ()
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there is a lien in favor of the United States on all property and rights to <. <- "
property belonging to this taxpayer for the amount of these taxes, and '"'Oc:; ~
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additional penalties, interest, and costs that may accrue. zr-- - -,
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Name of Taxpayer KEVIN B & DIANE L ROSS -<.-
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Residence z :::,.:,'
1121 APPLE DR ,......., :D
MECHANICSBURG, PA 17055-3920 =< fv -<
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IMPORTANT RELEASE INFORMATION: For each assessment listed below, CKJt ~63
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). ~Jt I 1 3059
Tax Period Date of Last Dal. for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Ref! ng of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/1989 199-52-1660 09/21/1992 10/21/2002 3442.66
1040 12/31/1991 199-52-1660 03/13/1995 04/12/2005 5451.73
Place of Filing
Prothonotary Total $
Cumberland County 8894.39
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
06th day of June
2001
the
Signature
Title
ACS
23-01-0000
for P SLANE (800) 829-7650
(MOTE: 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 I - Kept By Recording Office CAT. NO 60025X
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Fonn 668 (Z)
(Rev. 10-2000)
499
Department of the Treasury - Internal Revenue Service
Certificate of Release of Federal Tax Lien
Area:
WAGE " INVESTMENT AREA #2
Lien Unit Phone: (412) 395-5265
Serial Number
For Use by Recording Office
230176247
/1{. "500 0fI
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I certify that the following-named taxpayer, under the requirements of section 6325 (a)
of the Internal Revenue Code has satisfied the taxes listed below and all statutory
additions. Therefore, the lien provided by Code section 6321 for these taxes and
additions has been released, The proper officer in the office where the notice of
internal revenue tax lien was filed on June 18
2001 , is authorized to note the books to show the release of this lien for
these taxes and additions.
Name of Taxpayer
KEVIN B & DIANE L ROSS
Liber
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RECORDING INFORMATION:
Serial No.
01-3722 FTL
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Residence 1121 APPLE DR
MECHANICSBURG, PA 17055-3920
Page
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COURT
UCC No.
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Tax Period
Kind of Tax Ending Identifying Number
(a) (b) (c)
1040 12/31/1989 199-52-1660
1040 12/31/1991 199-52-1660
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Date of Last Day for
Assessment Refiling
(d) (e)
09/21/1992 10/21/2002
03/13/1995 04/12/2005
**********i************
Unpaid Balance
of Assessment
(f)
3442.66
5451.73
****************
.
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $
8894.39
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the 10th day of September, 2001
Signature
Title Compliance Technical Support
Manager
(NOTE: Certificate of officer authorized by law to take acknowledgments is not essential to the validity of Certificate of Release of
Federal Tax lien Rev, Rul. 71-466.1971 - 2 C,B, 4091 Form 668 (Z) (Rev, 10-20001
Part 1 . RECORDING OFFICE CAT, NO 600261
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