HomeMy WebLinkAbout03-51791008
Form 668 (Y)(c)
(Rev. October 2000)
Area: Serial Number
WAGE & INVESTMEATT AREA #2
Lien Unit Phone: (800) 829-7650 134970803
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 JERI L EBERTS
Residence
Department of the Treasury - Internal Revenue Service
Notice of Federal Tax Lien o3. F7- -
For Optional Use by Recording Office
57 S 39TH ST
CAMP HILL, PA 17011-4204
IMPORTANT RELEASE INFORMATION: For each assessment listed below,
unless notice of the lien is refiled by the date given in column (e), this notice shell,
on the day following such date, operate as a certificate of release as defined
in IRC 6325(a).
Tax Period Date of Last Day for Unpaid Balance
Kind of Tax Ending Identifying Number Assessment Refillng . of Assessment
(a) (b) (c) (d) (e) (f)
1040 12/31/2001 206-38-9925 06/03/2002 07/03/2012 11143.98
1040 12/31/2002 206-38-9925 05/26/2003 06/25/2013 369. 07
Place of Filing
Prothonotary
Cumberland County
Carlisle, PA 17013
Total $ 11513.05
This notice was prepared and signed at
PHILADELPHIA, PA
, on this,
the 18th day of September 2003
'~'/ ,~ n ! Title
Signature~.~/~for P /~' ~8CoS0) 829-7650 Z2-O0-O000
(NOTE: Certificate of officer authorized by law to take a~knowledgment 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. 10-00)
Pa~ I - Kept By R~ording O~ce CAT. NO 60025X