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Department of the Treasury - Internal Revenue Service
Form 668 (Y)(¢)
(Rev. October 2000)
Area:
SMALL BUSINESS/SELF EMPLOYED AREA #3
Lien Unit Phone: (800) 829-3903
Notice of Federal Tax Lien
111130703
Serial Number
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,
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 C~T,ES T, SHRETNER
Residence 408 E GREEN ST
SHIREMANSTOWN, PA 17011-6721
IIMPORTANT RELEASE INFOP~fATION: 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 IRC 6325(a).
For Optional Use by Recording Office
KindofTax
(a)
1040
1040
1040
1040
1040
Tax Period
Ending
(b)
: 12/31/1989
12/31/1990
12/31/1991
12/31/1992
12/31/1993
Identifying Number
(c)
195-26-4640
195-26-4640
195-26-4640
195-26-4640
195-26-4640
Date of
Assessment
(d)
04/28/1997
04/28/1997
04/28/1997
04/28/1997
04/28/1997
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Last Day for
Refihng
(e)
05/28/2007
05/28/2007
05/28/2007
05/28/2007
05/28/2007
Total
Unpaid Balance
of Assessment
(f)
1396.09
4071.10
3536.71
642.62
1767.49
$ 11414.01
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the 04th day of June 2003
Signature
, ~ ; ..... /.I Title
for L '4~~_~ 'o , _0o_oo0
(NOTE: Certificate of officer authorized by law to take acknowledgment is not essential to the validity of Notice of Federal Tax lien
Rev. aul. 71-466, 1971 - 2 C.B. 4091
Part ! - Kept By Recording Office Form 6&8(Y)(c) (Rev. 10-00)
CAT. NO 60025X