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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
WAGE & INVESTMENT AREA #2 ~.(J/- (.:2/1 F. /. L._
Lien Unit Phone: (800) 829-7650 230181103
As provided by section 6321, 6322, and 6323 of the Internal Revenue I!t. ' 9.dD
Code, we are giving a notice that taxes (including interest and penalties) Ut'f.t/~'
have been assessed aJgainst the following-named taxpayer. We have made CJe-.36V
a demand for payment of this liability, but it remains unpaid. Therefore, ~, //un
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
additional penalties, interest, and costs that may accrue.
Name of Taxpayer KELLY L CORBITT 0 C) 0
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Residence 4616 CLEARVIEW DR ~~_.-:-::, w F
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CAlVJP HILL, PA 17011-4012 -<4: ,:.~)(l.)
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IMPORTANT RfLEASE INFORMATION: For each assessment listed below, ~c5
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unless notice of the lien is refiled by the date given in column (et this notice shall, Z ~--i
on the day following such date, operate as a certificate of release as defined ~ :.....J. :D
in IRC 6325(a). -- -<
Tax Period Date of Last DaK. fOf' Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refi ng of Assessment
(a) (b) Cc) (d) (e) (f)
1040 12/31/1995 204-56-0330 09/14/1998 10/14/2008 3933.12
1040 12/31/1996 204-56-0330 09/14/1998 10/14/2008 4350.03
.
Place of Filing
Prothonotary Total $
Cumberland County 8283.15
Carlisle, PA 17013
This notice was prepared and signed at
PITTSBURGH, PA
, on this,
the
18th day of October
2001
Signature /J , ). j . Title
for P S LANE v~ a ~ ~~~O) 829-7650 23-01-0000
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. Ru!' 71-466,1971 - 2 C.B. 4091
Part 1 _ Kept By Recording Office Form 668(Y)(c) IRev. 10-00)
CAT. NO 60025X
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