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Department of the Treasury -Internal Revenue Service
F°'~" 66a (Y)(`~ Notice of Federal Tax Lien
(Rev. February 2004) ~p , Q
Area: Serial Number
SMALL BUSINESS/SELF EMPLOYED AREA #2
Lien Unit Phone: (800) 913-6050 362911107
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 JONATHAN WORTHINGTON
Residence 2 9 9 5 RITNER HWY
CARLISLE, PA 17015-7445
DETROIT, MI
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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 IRC 63251a).
Tax Period Date of Last Dayy for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refiling of Assessment
(a) (b) (c) (d) (e) (~
1040 12/31/2003 XXX-XX-5930 01/08/2007 02/07/2017. 12142.50
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
This notice was prepared and signed at
the 03rd day of May
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Office
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on this,
2007
Signature A -~ Title
TXPYR RES REP 11-07-1405
for GEORGE WEINHOLD (717) 221-3490
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For Optional Use by Rec
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Total ~ $ 1214 2 .5 0
(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. 2-2004)
Part 1 -Kept By Recording Office CAT. NO 60025X